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Minimal residual disease negativity in elderly patients with acute myeloid leukemia may indicate different postremission strategies than in younger patients

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Abstract

In the present analysis, we evaluated whether in elderly acute myeloid leukemia (AML) patients (>60 years), minimal residual disease (MRD) assessed by flow cytometry may have a role in guiding choice of postremission strategies. We analyzed 149 young and 61 elderly adults who achieved morphological CR after induction course of EORTC/GIMEMA protocols. Elderly patients reached a postconsolidation MRD negative status less frequently than younger ones (11 vs 28 %, p = 0.009). MRD negativity resulted in a longer 5-year disease-free survival (DFS) both in elderly (57 vs 13 %, p = 0.0197) and in younger patients (56 vs 31 %, p = 0.0017). Accordingly, 5-year cumulative incidence of relapse (CIR) of both elderly (83 vs 42 %, p = 0.045) and younger patients (59 vs 24 % p = NS) who were MRD positive doubled that of MRD negative ones. Nevertheless, CIR of MRD negative elderly patients was twofold higher than that of younger MRD negative ones (42 vs 24 %, p = NS). In conclusion, elderly patients in whom chemotherapy yields a MRD negative CR have duration of DFS and rate of CIR significantly better than those who remain MRD positive. Nonetheless, the high CIR rate observed in the elderly suggests that MRD negativity might have different therapeutic implications in this population than in the younger counterpart.

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Acknowledgments

This work was supported by a grant from Lazio Regional Agency for Transplantation and Related Diseases (IG grant 971/E); Ministero Istruzione Università Ricerca Projects Of National Relevance (PRIN, IG GRANT 20110AX25X7); Associazione Italiana Ricerca sul Cancro (IG grant 10555).

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Ematologia, Dipartimento di Biomedicina e Prevenzione, Università di Roma “Tor Vergata”, Roma, Italia

    F. Buccisano, L. Maurillo, M. I. Del Principe, M. Cefalo, C. Ditto, A. Di Veroli, G. De Santis, M. Irno Consalvo, D. Fraboni, P. Panetta, P. Palomba, C. Attrotto, G. Del Poeta, F. Lo-Coco, S. Amadori & A. Venditti

  2. Ematologia, Università Campus Bio-Medico, Roma, Italia

    A. Piciocchi

  3. Centro Dati Fondazione GIMEMA, Roma, Italia

    C. Sarlo

  4. Istituto di Farmacologia Traslazionale, Dipartimento di Medicina, Consiglio Nazionale delle Ricerche, Roma, Italia

    G. Sconocchia

  5. Laboratorio di Neuro-Oncoematologia, I.R.C.C.S.-Fondazione S. Lucia, Roma, Italia

    F. Lo-Coco

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  1. F. Buccisano
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  2. L. Maurillo
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Correspondence to F. Buccisano.

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Buccisano, F., Maurillo, L., Piciocchi, A. et al. Minimal residual disease negativity in elderly patients with acute myeloid leukemia may indicate different postremission strategies than in younger patients. Ann Hematol 94, 1319–1326 (2015). https://doi.org/10.1007/s00277-015-2364-5

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  • DOI: https://doi.org/10.1007/s00277-015-2364-5

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