RT Journal Article
SR Electronic
T1 Minimal residual disease prior to allogeneic hematopoietic cell transplantation in acute myeloid leukemia: a meta-analysis
JF Haematologica
JO Haematologica
FD Ferrata Storti Foundation
SP 865
OP 873
DO 10.3324/haematol.2016.159343
VO 102
IS 5
A1 Buckley, Sarah A.
A1 Wood, Brent L.
A1 Othus, Megan
A1 Hourigan, Christopher S.
A1 Ustun, Celalettin
A1 Linden, Michael A.
A1 DeFor, Todd E.
A1 Malagola, Michele
A1 Anthias, Chloe
A1 Valkova, Veronika
A1 Kanakry, Christopher G.
A1 Gruhn, Bernd
A1 Buccisano, Francesco
A1 Devine, Beth
A1 Walter, Roland B.
YR 2017
UL http://www.haematologica.org/content/102/5/865.abstract
AB Minimal residual disease prior to allogeneic hematopoietic cell transplantation has been associated with increased risk of relapse and death in patients with acute myeloid leukemia, but detection methodologies and results vary widely. We performed a systematic review and meta-analysis evaluating the prognostic role of minimal residual disease detected by polymerase chain reaction or multiparametric flow cytometry before transplant. We identified 19 articles published between January 2005 and June 2016 and extracted hazard ratios for leukemia-free survival, overall survival, and cumulative incidences of relapse and non-relapse mortality. Pre-transplant minimal residual disease was associated with worse leukemia-free survival (hazard ratio=2.76 [1.90–4.00]), overall survival (hazard ratio=2.36 [1.73–3.22]), and cumulative incidence of relapse (hazard ratio=3.65 [2.53–5.27]), but not non-relapse mortality (hazard ratio=1.12 [0.81–1.55]). These associations held regardless of detection method, conditioning intensity, and patient age. Adverse cytogenetics was not an independent risk factor for death or relapse. There was more heterogeneity among studies using flow cytometry-based than WT1 polymerase chain reaction-based detection (I2=75.1% vs. <0.1% for leukemia-free survival, 67.8% vs. <0.1% for overall survival, and 22.1% vs. <0.1% for cumulative incidence of relapse). These results demonstrate a strong relationship between pre-transplant minimal residual disease and post-transplant relapse and survival. Outcome heterogeneity among studies using flow-based methods may underscore site-specific methodological differences or differences in test performance and interpretation.