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Acute myeloid leukemia

Comparative analysis of total body irradiation (TBI)-based and non-TBI-based myeloablative conditioning for acute myeloid leukemia in remission with or without measurable residual disease

Leukemia volume 34, pages 1701–1705 (2020)Cite this article

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Myeloablative allogeneic hematopoietic cell transplantation (HCT) is commonly used in adults with acute myeloid leukemia (AML) in morphologic remission [1, 2]. Numerous conditioning regimens are available for this purpose, some containing total body irradiation (TBI) [3]. Despite several prospective randomized trials and large retrospective analyses, the benefit of high-dose TBI (HD-TBI; TBI doses ≥12 Gy) remains controversial [4]. Moreover, whether the relative value of HD-TBI- versus non-HD-TBI-based myeloablative conditioning differs depending on the pre-HCT measurable residual disease (MRD) status is unknown.

These questions prompted us to compare outcomes among adults ≥18 years with AML (based on 2016 WHO criteria [5]) who underwent a first allogeneic transplant in first or second morphologic remission at our institution after myeloablative conditioning using peripheral blood or bone marrow as a stem cell source. We included all transplants between 4/2006, when a refined multiparameter flow cytometry (MFC)-based MRD assay was introduced, and 1/2019. Patients were treated on Institutional Review Board-approved research protocols or standard treatment protocols and gave consent in accordance with the Declaration of Helsinki. Follow-up was current as of April 29, 2019.

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References

  1. Cornelissen JJ, Gratwohl A, Schlenk RF, Sierra J, Bornhäuser M, Juliusson G, et al. The European LeukemiaNet AML Working Party consensus statement on allogeneic HSCT for patients with AML in remission: an integrated-risk adapted approach. Nat Rev Clin Oncol. 2012;9:579–90.

    Article  CAS  Google Scholar 

  2. Döhner H, Estey E, Grimwade D, Amadori S, Appelbaum FR, Buchner T, et al. Diagnosis and management of AML in adults: 2017 ELN recommendations from an international expert panel. Blood. 2017;129:424–47.

    Article  Google Scholar 

  3. Gyurkocza B, Sandmaier BM. Conditioning regimens for hematopoietic cell transplantation: one size does not fit all. Blood. 2014;124:344–53.

    Article  CAS  Google Scholar 

  4. Storb R, Georges GE, Gooley TA. TBI- vs. chemotherapy-based myeloablative conditioning for allogeneic HCT. Biol Blood Marrow Transplant. 2019; pii: S1083-8791(19)30519-1. https://doi.org/10.1016/j.bbmt.2019.08.005. [Epub ahead of print].

  5. Arber DA, Orazi A, Hasserjian R, Thiele J, Borowitz MJ, Le Beau MM, et al. The 2016 revision to the World Health Organization classification of myeloid neoplasms and acute leukemia. Blood. 2016;127:2391–405.

    Article  CAS  Google Scholar 

  6. Grimwade D, Hills RK, Moorman AV, Walker H, Chatters S, Goldstone AH, et al. Refinement of cytogenetic classification in acute myeloid leukemia: determination of prognostic significance of rare recurring chromosomal abnormalities among 5876 younger adult patients treated in the United Kingdom Medical Research Council trials. Blood. 2010;116:354–65.

    Article  CAS  Google Scholar 

  7. Walter RB, Gooley TA, Wood BL, Milano F, Fang M, Sorror ML, et al. Impact of pretransplantation minimal residual disease, as detected by multiparametric flow cytometry, on outcome of myeloablative hematopoietic cell transplantation for acute myeloid leukemia. J Clin Oncol. 2011;29:1190–7.

    Article  Google Scholar 

  8. Walter RB, Buckley SA, Pagel JM, Wood BL, Storer BE, Sandmaier BM, et al. Significance of minimal residual disease before myeloablative allogeneic hematopoietic cell transplantation for AML in first and second complete remission. Blood. 2013;122:1813–21.

    Article  CAS  Google Scholar 

  9. Walter RB, Gyurkocza B, Storer BE, Godwin CD, Pagel JM, Buckley SA, et al. Comparison of minimal residual disease as outcome predictor for AML patients in first complete remission undergoing myeloablative or nonmyeloablative allogeneic hematopoietic cell transplantation. Leukemia. 2015;29:137–44.

    Article  CAS  Google Scholar 

  10. Araki D, Wood BL, Othus M, Radich JP, Halpern AB, Zhou Y, et al. Allogeneic hematopoietic cell transplantation for acute myeloid leukemia: is it time to move toward a minimal residual disease-based definition of complete remission. J Clin Oncol. 2016;34:329–36.

    Article  Google Scholar 

  11. Zhou Y, Othus M, Araki D, Wood BL, Radich JP, Halpern AB, et al. Pre- and post-transplant quantification of measurable (‘minimal’) residual disease via multiparameter flow cytometry in adult acute myeloid leukemia. Leukemia. 2016;30:1456–64.

    Article  CAS  Google Scholar 

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Acknowledgements

This work was supported by grants P01-CA078902, P01-CA018029, and P30-CA015704 from the National Cancer Institute/National Institutes of Health (NCI/NIH). The authors acknowledge the excellent care provided by the physicians and nurses of the HCT teams, the staff in the Long-Term Follow-up office at the Fred Hutchinson Cancer Research Center, the Hematopathology Laboratory at the University of Washington, and the patients for participating in our research protocols.

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Author notes

  1. Linde M. Morsink

    Present address: Department of Hematology, University Medical Center Groningen, Groningen, the Netherlands

  2. Evandro D. Bezerra

    Present address: Division of Hematology, Mayo Clinic, Rochester, MN, USA

  3. These author contributed equally: Linde M. Morsink, Evandro D. Bezerra

Authors and Affiliations

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

    Linde M. Morsink, Min Fang, Brenda M. Sandmaier, Marco B. Mielcarek, H. Joachim Deeg, Gary Schoch, Frederick R. Appelbaum & Roland B. Walter

  2. Department of Medicine, Residency Program, University of Washington, Seattle, WA, USA

    Evandro D. Bezerra

  3. Public Health Science Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    Megan Othus

  4. Department of Laboratory Medicine, University of Washington, Seattle, WA, USA

    Brent L. Wood

  5. Department of Pathology, University of Washington, Seattle, WA, USA

    Min Fang & Roland B. Walter

  6. Department of Medicine, Division of Medical Oncology, University of Washington, Seattle, WA, USA

    Brenda M. Sandmaier, Marco B. Mielcarek, H. Joachim Deeg & Frederick R. Appelbaum

  7. Department of Medicine, Division of Hematology, University of Washington, Seattle, WA, USA

    Roland B. Walter

  8. Department of Epidemiology, University of Washington, Seattle, WA, USA

    Roland B. Walter

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  1. Linde M. Morsink
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Correspondence to Roland B. Walter.

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Morsink, L.M., Bezerra, E.D., Othus, M. et al. Comparative analysis of total body irradiation (TBI)-based and non-TBI-based myeloablative conditioning for acute myeloid leukemia in remission with or without measurable residual disease. Leukemia 34, 1701–1705 (2020). https://doi.org/10.1038/s41375-019-0671-x

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