UCL logo

UCL Discovery

UCL home » Library Services » Electronic resources » UCL Discovery

Assessment of Minimal Residual Disease in Standard-Risk AML

Ivey, A; Hills, RK; Simpson, MA; Jovanovic, JV; Gilkes, A; Grech, A; Patel, Y; ... Grimwade, D; + view all (2016) Assessment of Minimal Residual Disease in Standard-Risk AML. The New England Journal Medicine , 374 (5) pp. 422-433. 10.1056/NEJMoa1507471. Green open access

[img]
Preview
Text
nejmoa1507471.pdf - ["content_typename_Published version" not defined]

Download (748kB) | Preview

Abstract

BACKGROUND: Despite the molecular heterogeneity of standard-risk acute myeloid leukemia (AML), treatment decisions are based on a limited number of molecular genetic markers and morphology-based assessment of remission. Sensitive detection of a leukemia-specific marker (e.g., a mutation in the gene encoding nucleophosmin [NPM1]) could improve prognostication by identifying submicroscopic disease during remission. METHODS: We used a reverse-transcriptase quantitative polymerase-chain-reaction assay to detect minimal residual disease in 2569 samples obtained from 346 patients with NPM1-mutated AML who had undergone intensive treatment in the National Cancer Research Institute AML17 trial. We used a custom 51-gene panel to perform targeted sequencing of 223 samples obtained at the time of diagnosis and 49 samples obtained at the time of relapse. Mutations associated with preleukemic clones were tracked by means of digital polymerase chain reaction. RESULTS: Molecular profiling highlighted the complexity of NPM1-mutated AML, with segregation of patients into more than 150 subgroups, thus precluding reliable outcome prediction. The determination of minimal-residual-disease status was more informative. Persistence of NPM1-mutated transcripts in blood was present in 15% of the patients after the second chemotherapy cycle and was associated with a greater risk of relapse after 3 years of follow-up than was an absence of such transcripts (82% vs. 30%; hazard ratio, 4.80; 95% confidence interval [CI], 2.95 to 7.80; P<0.001) and a lower rate of survival (24% vs. 75%; hazard ratio for death, 4.38; 95% CI, 2.57 to 7.47; P<0.001). The presence of minimal residual disease was the only independent prognostic factor for death in multivariate analysis (hazard ratio, 4.84; 95% CI, 2.57 to 9.15; P<0.001). These results were validated in an independent cohort. On sequential monitoring of minimal residual disease, relapse was reliably predicted by a rising level of NPM1-mutated transcripts. Although mutations associated with preleukemic clones remained detectable during ongoing remission after chemotherapy, NPM1 mutations were detected in 69 of 70 patients at the time of relapse and provided a better marker of disease status. CONCLUSIONS: The presence of minimal residual disease, as determined by quantitation of NPM1-mutated transcripts, provided powerful prognostic information independent of other risk factors. (Funded by Bloodwise and the National Institute for Health Research; Current Controlled Trials number, ISRCTN55675535.).

Type: Article
Title: Assessment of Minimal Residual Disease in Standard-Risk AML
Location: United States
Open access status: An open access version is available from UCL Discovery
DOI: 10.1056/NEJMoa1507471
Publisher version: http://dx.doi.org/10.1056/NEJMoa1507471
Language: English
Additional information: From Ivey, A; Hills, RK; Simpson, MA; Jovanovic, JV; Gilkes, A; Grech, A; Patel, Y; (2016) Assessment of Minimal Residual Disease in Standard-Risk AML. The New England Journal Medicine, 374 (5) pp. 422-433. Copyright © 2016 Massachusetts Medical Society. Reprinted with permission.
Keywords: Base Sequence, DNA, Neoplasm, Exome, Gene Expression Profiling, Humans, Leukemia, Myeloid, Acute, Molecular Sequence Data, Mutation, Neoplasm, Residual, Nuclear Proteins, Prognosis, Recurrence, Reverse Transcriptase Polymerase Chain Reaction, Risk Factors, Transcriptome
UCL classification: UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Cancer Institute
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Cancer Institute > Research Department of Haematology
URI: http://discovery.ucl.ac.uk/id/eprint/1475365
Downloads since deposit
217Downloads
Download activity - last month
Download activity - last 12 months
Downloads by country - last 12 months

Archive Staff Only

View Item View Item