Fiche publication
Date publication
septembre 2024
Journal
Leukemia
Auteurs
Membres identifiés du Cancéropôle Est :
Dr RENOSI Florian
Tous les auteurs :
Orvain C, Bertoli S, Peterlin P, Desbrosses Y, Dumas PY, Iat A, Hospital MA, Carre M, Tavernier E, Riou J, Bouvier A, Bidet A, Tondeur S, Renosi F, Mozziconacci MJ, Flandrin-Gresta P, Dadone-Montaudié B, Delabesse E, Pigneux A, Hunault-Berger M, Recher C
Lien Pubmed
Résumé
Patients with Core-Binding Factor (CBF) and NPM1-mutated acute myeloid leukemia (AML) can be monitored by quantitative PCR after having achieved first complete remission (CR) to detect morphologic relapse and drive preemptive therapy. How to best manage these patients is unknown. We retrospectively analyzed 303 patients with CBF and NPM1-mutated AML, aged 18-60 years, without allogeneic hematopoietic cell transplantation (HCT) in first CR, with molecular monitoring after first-line intensive therapy. Among these patients, 153 (51%) never relapsed, 95 (31%) had molecular relapse (53 received preemptive therapy and 42 progressed to morphologic relapse at salvage therapy), and 55 (18%) had upfront morphologic relapse. Patients who received preemptive therapy had higher OS than those who received salvage therapy after having progressed from molecular to morphologic relapse and those with upfront morphologic relapse (three-year OS: 78% vs. 51% vs. 51%, respectively, P = 0.01). Preemptive therapy included upfront allogeneic HCT (n = 19), intensive chemotherapy (n = 21), and non-intensive therapy (n = 13; three-year OS: 92% vs. 79% vs. 58%, respectively, P = 0.09). Although not definitive due to the non-randomized allocation of patients to different treatment strategies at relapse, our study suggests that molecular monitoring should be considered during follow-up to start preemptive therapy before overt morphologic relapse.
Mots clés
Humans, Nucleophosmin, Leukemia, Myeloid, Acute, genetics, Adult, Middle Aged, Female, Male, Nuclear Proteins, genetics, Adolescent, Young Adult, Mutation, Retrospective Studies, Recurrence, Hematopoietic Stem Cell Transplantation, methods, Core Binding Factors, genetics, Prognosis, Salvage Therapy, Remission Induction, Antineoplastic Combined Chemotherapy Protocols, therapeutic use, Neoplasm Recurrence, Local, genetics
Référence
Leukemia. 2024 09;38(9):1949-1957
