Factors associated with early treatment response in adults with acute myeloid leukemia
10.3760/cma.j.issn.0253-2727.2017.10.009
- VernacularTitle: 成人急性髓系白血病患者获得早期治疗反应的影响因素分析
- Author:
Xin REN
1
;
Ting ZHAO
;
Jing WANG
;
Honghu ZHU
;
Hao JIANG
;
Jinsong JIA
;
Shenmiao YANG
;
Bin JIANG
;
Debing WANG
;
Xiaojun HUANG
;
Qian JIANG
Author Information
1. Peking University People's Hospital, Peking University Institute of Hematology, Beijing 100044, China
- Publication Type:Journal Article
- Keywords:
Leukemia, myeloid, acute;
Morphologic leukemia-free state;
Early response
- From:
Chinese Journal of Hematology
2017;38(10):869-875
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the factors influencing early treatment responses in adult with de novo acute myeloid leukemia (AML) .
Methods:Data of consecutive newly-diagnosed AML (non-acute promyelocytic leukemia) adults were analyzed retrospectively. To assess the impact of clinical characteristics at diagnosis and induction regimen on achieving morphologic leukemia-free state (MLFS) , blood counts and minimal residual leukemia (MRD, positive MRD defined as RQ-PCR WT1 mRNA ≥0.6% and/or any level of abnormal blast population detected by flow cytometry) at the time of achieving MLFS.
Results:739 patients were included in this study. 406 (54.9%) patients were male, with a median age of 42 years (range, 18-65 years) . In the 721 evaluable patients, MLFS was achieved in 477 (66.2%) patients after the first induction regimen and 592 (82.1%) within two cycles. A total of 634 patients (87.9%) achieved MLFS, including 534 (84.2%) achieving a complete remission (CR, defined as MLFS with ANC ≥ 1×109/L and PLT ≥ 100×109/L) , 100 (15.8%) achieving a CRi (defined as MLFS with incomplete ANC or PLT recovery) , respectively. 260 (45.9%) patients of 566 (89.3%) who detected MRD at the time of achieving MLFS had positive MRD. Multivariate analyses showed that female gender, favorable-risk of SWOG criteria, IA10 and HAA/HAD as induction regimen were factors associated with achieving early MLFS. In addition, low bone marrow blasts, HGB ≥ 80 g/L, PLT counts<30×109/L and mutated NPM1 without FLT3-ITD were factors associated with achieving MLFS after the first induction regimen; Negative FLT3-ITD mutation was factor associated with achieving MLFS within two cycles. PLT counts ≥30×109/L and IA10, IA8 or HAA/HAD as induction chemotherapy were factors associated with achieving CR. Female gender, favorable-risk of SWOG criteria, FLT3-ITD mutation negative, mutated NPM1 without FLT3-ITD were factors associated with negative MRD.
Conclusions:Female gender, favorable molecular markers or cytogenetics, and standard-dose induction regimen were key factors associated with higher probability of early and deep responses in adults with AML.
