Original Article | Published:

Minimal Residual Disease

Comparison of minimal residual disease as outcome predictor for AML patients in first complete remission undergoing myeloablative or nonmyeloablative allogeneic hematopoietic cell transplantation

Leukemia volume 29, pages 137144 (2015) | Download Citation

Presented in part at the 55th Annual Meeting of the American Society of Hematology; 7–10 December 2013; New Orleans, LA, USA, Version: 1 May 2014.

Abstract

Minimal residual disease (MRD) is associated with adverse outcome in acute myeloid leukemia (AML) after myeloablative (MA) hematopoietic cell transplantation (HCT). We compared this association with that seen after nonmyeloablative (NMA) conditioning in 241 adults receiving NMA (n=86) or MA (n=155) HCT for AML in first remission with pre-HCT bone marrow aspirates assessed by flow cytometry. NMA patients were older and had more comorbidities and secondary leukemias. Three-year relapse estimates were 28% and 57% for MRDneg and MRDpos NMA patients, and 22% and 63% for MA patients. Three-year overall survival (OS) estimates were 48% and 41% for MRDneg and MRDpos NMA patients and 76% and 25% for MA patients. This similar OS after NMA conditioning was largely accounted for by higher non-relapse mortality (NRM) in MRDneg (30%) compared with MRDpos (10%) patients, whereas the reverse was found for MRDneg (7%) and MRDpos (23%) MA patients. A statistically significant difference between MA and NMA patients in the association of MRD with OS (P<0.001) and NRM (P=0.002) but not relapse (P=0.17) was confirmed. After adjustment, the risk of relapse was 4.51 times (P<0.001) higher for MRDpos patients. These data indicate that the negative impact of MRD on relapse risk is similar after NMA and MA conditioning.

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Acknowledgements

Research reported in this publication was supported by grants P01-CA078902, P01-CA018029 and R00-HL088021 from the National Cancer Institute/National Institutes of Health, Bethesda, MD, USA. RBW is a Leukemia and Lymphoma Society Scholar in Clinical Research. SAB is the recipient of a Trainee Research Award and a ‘Hematology Opportunity for the Next-Generation of Research Scientists’ (HONORS) Award from the American Society of Hematology.

Author information

Affiliations

  1. Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    • R B Walter
    • , B Gyurkocza
    • , B E Storer
    • , J M Pagel
    • , M L Sorror
    • , R Storb
    • , F R Appelbaum
    •  & B M Sandmaier
  2. Division of Hematology, Department of Medicine, University of Washington, Seattle, WA, USA

    • R B Walter
  3. Department of Epidemiology, University of Washington, Seattle, WA, USA

    • R B Walter
  4. Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, USA

    • B Gyurkocza
    • , J M Pagel
    • , M L Sorror
    • , R Storb
    • , F R Appelbaum
    •  & B M Sandmaier
  5. Department of Medicine, Residency Program, University of Washington, Seattle, WA, USA

    • C D Godwin
    •  & S A Buckley
  6. Division of Hematopathology, Department of Laboratory Medicine, University of Washington, Seattle, WA, USA

    • B L Wood

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Competing interests

The authors declare no conflict of interest.

Corresponding author

Correspondence to R B Walter.

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DOI

https://doi.org/10.1038/leu.2014.173

Supplementary Information accompanies this paper on the Leukemia website (http://www.nature.com/leu)

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