Prognostic markers in core-binding factor AML and improved survival with multiple consolidation cycles of intermediate-/high-dose cytarabine

Ashvind Prabahran, Mark Tacey, Shaun Fleming, Andrew Wei, Courtney Tate, Paula Marlton, Joel Wight, Andrew Grigg, Annabel Tuckfield, Jeff Szer, David Ritchie, Lynette Chee

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4 Citations (Scopus)

Abstract

Objectives: Core-binding factor acute myeloid leukaemia (CBF AML) defined by t(8;21)(q22;q22) or inv(16)(p13q22)/t(16;16)(p13;q22) has a favourable prognosis; however, 30%-40% of patients still relapse after chemotherapy. We sought to evaluate the risk factors for relapse in a de novo CBF AML cohort. Patients/Materials/Methods: A retrospective review of patients from four Australian tertiary centres from 2001 to 2012, comprising 40 t(8;21) and 30 inv(16) AMLs. Results: Multivariate analysis identified age (P =.032) and white cell count (WCC)>40 (P =.025) as significant predictors for inferior OS and relapse, respectively. Relapse risk was higher in the inv(16) group vs the t(8;21) group (57% vs 18%, HR 4.31, 95% CI: 1.78-10.42, P =.001). Induction therapy had no bearing on OS or relapse-free survival (RFS); however, consolidation treatment with >3 cycles of intermediate-/high-dose cytarabine improved OS (P =.035) and RFS (P =.063). Five patients demonstrated post-treatment stable q PCR positivity without relapse. Conclusions: >3 consolidation cycles of intermediate-/high-dose cytarabine improves patient outcomes Age and inv(16) CBF AML subtype are predictors of inferior OS and RFS, respectively. Stable low-level MRD by qPCR does not predict relapse Similar OS in the inv(16) cohort compared to the t(8;21) cohort, despite a higher relapse rate, confirms salvageability of relapsed disease.

Original languageEnglish
Pages (from-to)174-184
Number of pages11
JournalEuropean Journal of Haematology
Volume101
Issue number2
DOIs
Publication statusPublished - 1 Aug 2018
Externally publishedYes

Keywords

  • acute myeloid leukaemia
  • core-binding factors
  • prognosis

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