Article Dans Une Revue Leukemia Année : 2024

Molecular relapse after first-line intensive therapy in patients with CBF or NPM1-mutated acute myeloid leukemia – a FILO study

Corentin Orvain
Sarah Bertoli
Pierre Peterlin
  • Fonction : Auteur
Yohann Desbrosses
  • Fonction : Auteur
Pierre-Yves Dumas
  • Fonction : Auteur
Alexandre Iat
Marie-Anne Hospital
  • Fonction : Auteur
Martin Carre
  • Fonction : Auteur
Emmanuelle Tavernier
Anne Bouvier
Audrey Bidet
Sylvie Tondeur
  • Fonction : Auteur
Florian Renosi
Marie-Joelle Mozziconacci
  • Fonction : Auteur
Pascale Flandrin-Gresta
  • Fonction : Auteur
Bérengère Dadone-Montaudié
  • Fonction : Auteur
  • PersonId : 1249336
Eric Delabesse
Arnaud Pigneux
Mathilde Hunault-Berger
Christian Recher
  • Fonction : Auteur

Résumé

Abstract 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.
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Dates et versions

hal-04783712 , version 1 (14-01-2025)

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Citer

Corentin Orvain, Sarah Bertoli, Pierre Peterlin, Yohann Desbrosses, Pierre-Yves Dumas, et al.. Molecular relapse after first-line intensive therapy in patients with CBF or NPM1-mutated acute myeloid leukemia – a FILO study. Leukemia, 2024, 38 (9), pp.1949-1957. ⟨10.1038/s41375-024-02335-2⟩. ⟨hal-04783712⟩
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