Acute myeloid leukemia: negative prognostic impact of early blast persistence can be in part overcome by a later remission prior to post-induction therapy
Jana Ihlow,
Sophia Gross,
Leonie Busack,
Anne Flörcken,
Julia Jesse,
Michaela Schwarz,
Nina Rosa Neuendorff,
Ann-Christin von Brünneck,
Ioannis Anagnostopoulos,
Seval Türkmen,
Igor Wolfgang Blau,
Thomas Burmeister,
David Horst,
Lars Bullinger,
Jörg Westermann
Affiliations
Jana Ihlow
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
Sophia Gross
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
Leonie Busack
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
Anne Flörcken
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; Labor Berlin Charité Vivantes GmbH, Sylter Straße 2, 13353 Berlin
Julia Jesse
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
Michaela Schwarz
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
Nina Rosa Neuendorff
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
Ann-Christin von Brünneck
Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Pathology, Charitéplatz 1, 10117 Berlin
Ioannis Anagnostopoulos
Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Pathology, Charitéplatz 1, 10117 Berlin
Seval Türkmen
Labor Berlin Charité Vivantes GmbH, Sylter Straße 2, 13353 Berlin, Germany; Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Department of Medical Genetics and Human Genetics, Augustenburger Platz 1, 13353 Berlin
Igor Wolfgang Blau
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; Labor Berlin Charité Vivantes GmbH, Sylter Straße 2, 13353 Berlin
Thomas Burmeister
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; Labor Berlin Charité Vivantes GmbH, Sylter Straße 2, 13353 Berlin
David Horst
Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Pathology, Charitéplatz 1, 10117 Berlin
Lars Bullinger
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; Labor Berlin Charité Vivantes GmbH, Sylter Straße 2, 13353 Berlin
Jörg Westermann
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; Labor Berlin Charité Vivantes GmbH, Sylter Straße 2, 13353 Berlin
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.
