The prognostic impact of reduced variant burden in elderly patients with acute myeloid leukemia treated with decitabine
- Author:
Mihee KIM
1
;
TaeHyung KIM
;
Seo-Yeon AHN
;
Jun Hyung LEE
;
Ju Heon PARK
;
Myung-Geun SHIN
;
Sung-Hoon JUNG
;
Ga-Young SONG
;
Deok-Hwan YANG
;
Je-Jung LEE
;
Seung Hyun CHOI
;
Mi Yeon KIM
;
Jae-Sook AHN
;
Hyeoung-Joon KIM
;
Dennis Dong Hwan KIM
Author Information
- Publication Type:2
- From:The Korean Journal of Internal Medicine 2023;38(4):534-545
- CountryRepublic of Korea
- Language:English
-
Abstract:
Background/Aims:We evaluated the role of next-generation sequencing (NGS)-based disease monitoring for elderly patients diagnosed with acute myeloid leukemia (AML) who received decitabine therapy.
Methods:A total of 123 patients aged > 65 years with AML who received decitabine were eligible. We analyzed the dynamics of variant allele frequency (VAF) in 49 available follow-up samples after the fourth cycle of decitabine. The 58.6% VAF clearance (Δ, [VAF at diagnosis − VAF at follow-up] × 100 / VAF at diagnosis) was the optimal cut-off for predicting overall survival (OS).
Results:The overall response rate was 34.1% (eight patients with complete remission [CR], six of CR with incomplete hematologic recovery, 22 with partial responses, and six with morphologic leukemia-free status). Responders (n = 42) had significantly better OS compared with non-responders (n = 42) (median, 15.3 months vs. 6.5 months; p < 0.001). Of the 49 patients available for follow-up targeted NGS analysis, 44 had trackable gene mutations. The median OS of patients with ΔVAF ≥ 58.6% (n=24) was significantly better than that of patients with ΔVAF < 58.6% (n = 19) (20.5 months vs. 9.8 months, p = 0.010). Moreover, responders with ΔVAF ≥ 58.6% (n = 20) had a significantly longer median OS compared with responders with VAF < 58.6% (n = 11) (22.5 months vs. 9.8 months, p = 0.004).
Conclusions:This study suggested that combining ΔVAF ≥ 58.6%, a molecular response, with morphologic and hematologic responses can more accurately predict OS in elderly AML patients after decitabine therapy.
