Hirsch Pierre, Lambert Jérôme, Bucci Maxime, Deswarte Caroline, Boudry Augustin, Lambert Juliette, Fenwarth Laurene, Micol Jean-Baptiste, Terré Christine, Celli-Lebras Karine, Thomas Xavier, Dombret Hervé, Duployez Nicolas, Preudhomme Claude, Itzykson Raphael, Delhommeau Francois
Sorbonne Université, INSERM, Centre de Recherche Saint-Antoine, CRSA, AP-HP, SIRIC CURAMUS, Hôpital Saint-Antoine, Service d'Hématologie Biologique, 75012, Paris, France.
Biostatistics and Medical Information Department, Hôpital Saint Louis, Paris, France.
Blood Cancer J. 2024 Jun 13;14(1):97. doi: 10.1038/s41408-024-01078-8.
The evaluation of measurable residual disease (MRD) in acute myeloid leukemia (AML) using comprehensive mutation analysis by next-generation sequencing (NGS) has been investigated in several studies. However controversial results exist regarding the detection of persisting mutations in DNMT3A, TET2, and ASXL1 (DTA). Benchmarking of NGS-MRD taking into account other molecular MRD strategies has to be done. Here, we performed error-corrected-NGS-MRD in 189 patients homogeneously treated in the ALFA-0702 study (NCT00932412). Persistence of non-DTA mutations (HR = 2.23 for RFS and 2.26 for OS), and DTA mutations (HR = 2.16 for OS) were associated with poorer prognosis in multivariate analysis. Persistence of at least two mutations in complete remission (CR) was associated with a higher cumulative incidence of relapse (CIR) (HR = 3.71, p < 0.0001), lower RFS (HR = 3.36, p < 0.0001) and OS (HR = 3.81, p = 0.00023) whereas persistence of only one mutation was not. In 100 analyzable patients, WT1-MRD, but not NGS-MRD, was an independent factor for RFS and OS. In the subset of 67 NPM1 mutated patients, both NPM1 mutation detection (p = 0.0059) and NGS-MRD (p = 0.035) status were associated with CIR. We conclude that detectable NGS-MRD including DTA mutations correlates with unfavorable prognosis in AML. Its integration with alternative MRD strategies in AML management warrants further investigations.
多项研究对采用下一代测序(NGS)进行全面突变分析来评估急性髓系白血病(AML)中的微小残留病(MRD)展开了调查。然而,在检测DNA甲基转移酶3A(DNMT3A)、TET2和ASXL1(DTA)中持续存在的突变方面,存在有争议的结果。必须对考虑了其他分子MRD策略的NGS-MRD进行基准测试。在此,我们对在ALFA-0702研究(NCT00932412)中接受同质化治疗的189例患者进行了纠错NGS-MRD检测。在多变量分析中,非DTA突变的持续存在(无复发生存期[RFS]的风险比[HR] = 2.23,总生存期[OS]的HR = 2.26)以及DTA突变(OS的HR = 2.16)与较差的预后相关。完全缓解(CR)时至少两个突变的持续存在与更高的复发累积发生率(CIR)相关(HR = 3.71,p < 0.0001),RFS较低(HR = 3.36,p < 0.0001)以及OS较低(HR = 3.81,p = 0.00023),而仅一个突变的持续存在则不然。在100例可分析的患者中,WT1-MRD而非NGS-MRD是RFS和OS的独立因素。在67例核磷蛋白1(NPM1)突变的患者亚组中,NPM1突变检测状态(p = 0.0059)和NGS-MRD状态(p = 0.035)均与CIR相关。我们得出结论,可检测到的包括DTA突变在内的NGS-MRD与AML的不良预后相关。在AML管理中将其与替代MRD策略相结合值得进一步研究。
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