In the late-breaking abstracts session, Dr Christopher Hourigan (NIH, USA) presented the results of preconditioning samples from 188 AML patients in the 0901 trial. The patients were well matched with respect to baseline characteristics, including age, sex, disease risk, donor type, donor match, and graft type.
A previous analysis of this study compared the outcomes of AML patients in remission, following 1 of 2 forms of pre-transplant preparative therapy, either high-intensity myeloablative conditioning (MAC) or reduced-intensity conditioning (RIC), relapsed within 18 months after transplant [2]. They found that 31% of patients in the high-intensity myeloablative group and 33% in the reduced-intensity group had no genomic variants indicative of MRD. Subsequent survival rates did not differ among those groups (3-year overall survival: 58% vs 65%; P=0.98). However, among the patients with detectable variants indicative of MRD prior to conditioning, the 3-year overall survival rate was significantly better for the patients in the high-intensity conditioning group than for those in the reduced-intensity group (61% vs 44%; P=0.02).
The researchers assessed MRD using a next-generation, ultra-deep, error-corrected genomic sequencing technology that is currently available only for research purposes, Dr Hourigan explained. However, he said the findings underscore a role for MRD testing in the future. Overall, 76% of patients who experienced relapse had at least 1 detectable variant prior to conditioning. After adjusting for factors that included the level of disease risk and donor group, patients with detectable variants indicating MRD who went on to receive the reduced-intensity conditioning had a nearly 6 times greater risk for relapse (HR 5.98; 95% CI 3.19-11.26; P<0.001).
For these patients, disease-free survival was significantly decreased (HR 2.80; 95% CI 1.76-4.44; P<0.001), as was overall survival (HR 2.16; 95% CI 1.30-3.60; P=0.003), when compared with the higher-intensity conditioning group. Although in the original trial mortality related to toxicity from the treatment itself was significantly higher among the patients who received the high-intensity regimen, the new findings suggest the risk/benefit balance may be offset by this MRD finding, said Dr Hourigan.
"As a physician who treats acute leukaemia patients, these findings for me open up many interesting questions and some obvious opportunities for potentially improving the therapeutic outcomes for our AML patients," Dr Hourigan concluded.
- Hourigan C, et al. Abstract LB2600, 24th Congress of the EHA, 13-16 June 2019, Amsterdam, the Netherlands.
- Scott BL, et al. J Clin Oncol. 2017 Apr 10;35(11):1154-1161.
Posted on
Previous Article
« Transformation of foetal haematopoietic stem and progenitor cells in the background of trisomy 21 Next Article
Introduction to the Conference Report of the EHA »
« Transformation of foetal haematopoietic stem and progenitor cells in the background of trisomy 21 Next Article
Introduction to the Conference Report of the EHA »
Table of Contents: EHA 2019
Featured articles
Editor Biography
Interview with EHA President Prof. Pieter Sonneveld
Myeloid Malignancies
Residual disease in AML patients prior to stem cell transplant increases relapse risk
Gilteritinib prolongs overall survival in patients with FLT3-mutated relapsed/refractory AML
Initial data on AMV564 in patients with relapsed/refractory AML
Overcoming the ādonāt eat meā signal in AML and MDS
Asciminib plus imatinib in patients with heavily pre-treated chronic myeloid leukaemia
Guadecitabine vs treatment of choice in AML
Lymphoid Malignancies
Unmutated IGHV as predictive factor for venetoclax/obinutuzumab benefit in frontline CLL
CAR-T cell therapy in ALL as breakthrough advance
Brentuximab vedotin continues to demonstrate superior clinical activity in classical Hodgkin lymphoma
Infectious complications mild and not common in patients receiving CAR-T therapy for diffuse large B cell lymphoma
Obinutuzumab/polatuzumab in follicular lymphoma
Exciting survival data for ibrutinib vs placebo in treatment-naĆÆve, early-stage CLL
ASCEND study: Acalabrutinib improves progression-free survival in relapsed/refractory CLL
Venetoclax-obinutuzumab combination elicits high response rates in CLL
Myeloma
CASSIOPEIA trial: Phase 3 results of daratumumab + bortezomib/thalidomide/dexamethasone in multiple myeloma
Chimeric antigen receptor T cell therapy in multiple myeloma
Higher levels of treatment satisfaction without compromising efficacy: subcutaneous daratumumab in RRMM
Adding isatuximab to pomalidomide and dexamethasone improves PFS and ORR in RRMM
Subcutaneous daratumumab + cyclophosphamide, bortezomib, and dexamethasone in patients with newly diagnosed amyloid light chain amyloidosis
Venetoclax for multiple myeloma: effective but some safety concerns
Benign Haematology
New sickle cell drug voxelotor boosts levels of haemoglobin
Positive initial data evaluating the safety and efficacy of IMR-687 for treatment of sickle cell disease
Haematopoietic stem cell transplantation improves stroke risk in children with sickle cell anaemia
Early trial data shows positive results for treating anaemia in patients with end-stage renal failure
Bench-to-Bedside
Transformation of foetal haematopoietic stem and progenitor cells in the background of trisomy 21
Treating thalassemia twice, in mice
Haematopoietic stem cells can sense tissue damage in the gut
Promising news for gene therapy for sickle cell disease
Related Articles
Ā© 2024 Medicom Medical Publishers. All rights reserved. Terms and Conditions | Privacy Policy
HEAD OFFICE
Laarderhoogtweg 25
1101 EB Amsterdam
The Netherlands
T: +31 85 4012 560
E: publishers@medicom-publishers.com