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Acute Leukemia

Identification of molecular and cytogenetic risk factors for unfavorable core-binding factor-positive adult AML with post-remission treatment outcome analysis including transplantation

Bone Marrow Transplantation volume 49, pages 1466–1474 (2014)Cite this article

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Abstract

Emerging molecular studies have identified a subgroup of patients with unfavorable core-binding factor-positive (CBF)-AML who should be treated by intensified post-remission treatments. We analyzed 264 adults with CBF-AML from 2002 to 2011, and focused on 206 patients who achieved CR after standard ‘3+7’ induction chemotherapy. Patients who achieved CR with an available donor were treated with allogeneic hematopoietic SCT (allo-HSCT, n=115) and the rest were treated with autologous (auto) HSCT (n=72) or chemotherapy alone (n=19). OS was not significantly different between CBFβ/MYH11 (n=62) and RUNX1/RUNX1T1 (n=144), and auto-HSCT showed favorable OS compared with allo-HSCT or chemotherapy alone. Cytogenetic analysis identified that inv(16) without trisomy had a favorable OS and t(8;21) with additional chromosomes had an unfavorable OS, but multivariate analysis revealed those were NS. Patients with c-kit mutation showed inferior OS. For transplanted patients, residual post-transplant CBF-minimal residual disease quantitative PCR with higher WT1 expression at D+60 showed the worst OS with a higher incidence of relapse. Conclusively, we found that unfavorable CBF-AML can be defined with risk stratification using cytogenetic and molecular studies, and a careful risk-adapted treatment approach using frontline transplantation with novel therapies should be evaluated for this particular risk subgroup.

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Acknowledgements

This study was supported by a grant from the National R&D Program for Cancer Control, Ministry for Health and Welfare, Republic of Korea (1020370).

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  1. Department of Hematology, Catholic Blood and Marrow Transplantation Center, Cancer Research Institute, Seoul St Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

    J-H Yoon, H-J Kim, J-W Kim, Y-W Jeon, S-H Shin, S-E Lee, B-S Cho, K-S Eom, Y-J Kim, S Lee, C-K Min, S-G Cho, J-W Lee, W-S Min & C-W Park

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Yoon, JH., Kim, HJ., Kim, JW. et al. Identification of molecular and cytogenetic risk factors for unfavorable core-binding factor-positive adult AML with post-remission treatment outcome analysis including transplantation. Bone Marrow Transplant 49, 1466–1474 (2014). https://doi.org/10.1038/bmt.2014.180

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