Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Hematology, Oncology and Tumor Immunology, Campus Virchow Clinic, Augustenburger Platz 1, 13353 Berlin, Germany; Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Pathology, Charitéplatz 1, 10117 Berlin.
Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Hematology, Oncology and Tumor Immunology, Campus Virchow Clinic, Augustenburger Platz 1, 13353 Berlin.
Haematologica. 2022 Aug 1;107(8):1773-1785. doi: 10.3324/haematol.2021.279134.
In acute myeloid leukemia, there is an ongoing debate on the prognostic value of the early bone marrow assessment in patients receiving intensive therapy. In this retrospective study, we analyzed the prognostic impact of the early response in 1,008 patients with newly diagnosed acute myeloid leukemia, who were treated at our institution with intensive chemotherapy followed by consolidation chemotherapy and/or allogeneic hematopoietic stem cell transplantation (HSCT). We found that early blast persistence has an independent negative prognostic impact on overall survival, eventfree survival and relapse-free survival. This negative prognostic impact may only be overcome in patients showing at least a partial remission at the early bone marrow assessment and who subsequently achieve blast clearance by additional induction chemotherapy prior to consolidation therapy with allogeneic HSCT. In accordance, we propose that the time slope of remission is an additional leukemia-related dynamic parameter that reflects chemosensitivity and thus may inform post-induction therapy decision-making. In addition to patient-related factors, European LeukemiaNet risk group, measurable residual disease monitoring and donor availability, this may particularly apply to European LeukemiaNet intermediate-risk patients, for whom a decision between consolidation chemotherapy and allogeneic HSCT remains challenging in many cases.
在急性髓系白血病中，对于接受强化治疗的患者，早期骨髓评估的预后价值存在持续争议。在这项回顾性研究中，我们分析了 1008 例新诊断的急性髓系白血病患者的早期反应对预后的影响，这些患者在我院接受强化化疗，随后进行巩固化疗和/或异基因造血干细胞移植（HSCT）。我们发现早期原始细胞持续存在对总生存期、无事件生存期和无复发生存期有独立的负预后影响。这种负预后影响仅在早期骨髓评估时至少达到部分缓解且随后在巩固治疗前通过额外的诱导化疗实现原始细胞清除的患者中才能克服。因此，我们提出缓解的时间斜率是一个额外的与白血病相关的动态参数，反映了化疗敏感性，因此可能有助于指导诱导后治疗决策。除了患者相关因素、欧洲白血病网风险组、可测量残留疾病监测和供者可用性外，这可能特别适用于欧洲白血病网中危患者，在许多情况下，这些患者在巩固化疗和异基因 HSCT 之间的决策仍然具有挑战性。
