Prognostic significance of multiparametric flow cytometry minimal residual disease at two time points after induction in pediatric acute myeloid leukemia
Yongzhi Zheng,
Lili Pan,
Jian Li,
Xiaoqin Feng,
Chunfu Li,
Mincui Zheng,
Huirong Mai,
Lihua Yang,
Yingyi He,
Xiangling He,
Honggui Xu,
Hong Wen,
Shaohua Le
Affiliations
Yongzhi Zheng
Department of Pediatric Hematology, Fujian Institute of Hematology, Fujian Provincial Key Laboratory On Hematology, Fujian Medical University Union Hospital
Lili Pan
Department of Pediatric Hematology, Fujian Institute of Hematology, Fujian Provincial Key Laboratory On Hematology, Fujian Medical University Union Hospital
Jian Li
Department of Pediatric Hematology, Fujian Institute of Hematology, Fujian Provincial Key Laboratory On Hematology, Fujian Medical University Union Hospital
Xiaoqin Feng
Department of Pediatrics, Nanfang Hospital, Southern Medical University
Chunfu Li
Nanfang-Chunfu Children’s Institute of Hematology & Oncology, TaiXin Hospital
Mincui Zheng
Department of Pediatric Hematology/Oncology, Hematology and Oncology, Hunan Children’s Hospital
Huirong Mai
Department of Pediatric Hematology/Oncology, Shenzhen Children’s Hospital
Lihua Yang
Department of Pediatrics, Zhujiang Hospital of Southern Medical University
Yingyi He
Department of Pediatric Hematology/Oncology, Guangzhou Women and Children’s Medical Center
Xiangling He
People’s Hospital of Hunan Province
Honggui Xu
Sun Yat-Sen Memorial Hospital
Hong Wen
The First Affiliated Hospital of Xiamen University
Shaohua Le
Department of Pediatric Hematology, Fujian Institute of Hematology, Fujian Provincial Key Laboratory On Hematology, Fujian Medical University Union Hospital
Abstract Background Prompt response to induction chemotherapy is a prognostic factor in pediatric acute myeloid leukemia. In this study, we aimed to evaluate the prognostic significance of multiparametric flow cytometry-minimal residual disease (MFC-MRD), assessed at the end of the first and second induction courses. Methods MFC-MRD was performed at the end of the first induction (TP1) in 524 patients and second induction (TP2) in 467 patients who were treated according to the modified Medical Research Council (UK) acute myeloid leukemia 15 protocol. Results Using a 0.1% cutoff level, patients with MFC-MRD at the two time points had lower event-free survival and overall survival. Only the TP2 MFC-MRD level could predict the outcome in a separate analysis of high and intermediate risks based on European LeukemiaNet risk stratification and KMT2A rearrangement. The TP2 MFC-MRD level could further differentiate the prognosis of patients into complete remission or non-complete remission based on morphological evaluation. Multivariate analysis indicated the TP2 MFC-MRD level as an independent adverse prognostic factor for event-free survival and overall survival. When comparing patients with MFC-MRD ≥ 0.1%, those who underwent hematopoietic stem cell transplant during the first complete remission had significantly higher 5-year event-free survival and overall survival and lower cumulative incidence of relapse than those who only received consolidation chemotherapy. Conclusions The TP2 MFC-MRD level can predict the outcomes in pediatric patients with acute myeloid leukemia and help stratify post-remission treatment.
