Relapse surveillance of acute myeloid leukemia patients in first remission after consolidation chemotherapy: diagnostic value of regular bone marrow aspirations

Abstract

‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬AbstractThe optimal follow-up care for relapse detection in acute myeloid leukemia (AML) patients in first remission after consolidation therapy with intensive chemotherapy is not established. In this retrospective study, we evaluate the diagnostic value of an intensive relapse surveillance strategy by regular bone marrow aspirations (BMA) in these patients. We identified 86 patients with newly diagnosed non-promyelocytic AML who had reached complete remission (CR) after intensive induction and consolidation chemotherapy between 2007 and 2019. Annual relapse rates were 40%, 17%, and 2% in years 1–3, respectively. Patients in CR were surveilled by BMA scheduled every 3 months for 2 years, followed by BMA every 6 months. This surveillance regimen detected 29 of 55 relapses (53%), 11 of which were molecular relapses (20%). The remaining 26 of 55 relapses (47%) were diagnosed by non-surveillance BMA prompted by specific suspicion of relapse. Most patients showed concurrent morphological abnormalities in peripheral blood (PB) at time of relapse. Seven percent of all morphological relapses occurred without simultaneous PB abnormalities and would have been delayed without surveillance BMA. Intensified monthly PB assessment paired with BMA every 3 months during the first 2 years may be a highly sensitive relapse surveillance strategy.

Socioeconomic Status and Overall Survival Among Patients With Hematological Malignant Neoplasms

“…This observation could indicate that differences in outcome are related to the management of treatment-related complications and primary refractory or relapsed disease, since most relapses occur within the first 2 to 3 years after the achievement of complete remission. 35,36 Consistent with this observation, a 2017 study found that marital status and neighborhood SES are independent risk factors for 60-day mortality in patients with AML. 37 In addition, the management of common complications related to the treatment of AML, ie, neutropenic infections, where rapid antibiotic management is required, 38 could also contribute to this difference.…”

“…When examining the survival difference in AML, we found that most of the increased hazard for the low SES group was within 2 years after diagnosis. This observation could indicate that differences in outcome are related to the management of treatment-related complications and primary refractory or relapsed disease, since most relapses occur within the first 2 to 3 years after the achievement of complete remission . Consistent with this observation, a 2017 study found that marital status and neighborhood SES are independent risk factors for 60-day mortality in patients with AML .…”

The evolution of minimal residual disease: key insights based on a bibliometric visualization analysis from 2002 to 2022

“…Minimal residual disease (MRD) denotes the existence of malignant cells that remain in the body of a cancer patient following a particular treatment regimen, without clinical symptoms or signs of disease, and is not detectable by cellular morphology or routine screening methods. This elucidates the reasons that the majority of patients who attain a state of the complete response still relapse within years (1)(2)(3). MRD mainly applies to hematological malignancies and solid tumors (4).…”

Oxidative stress is two‐sided in the treatment of acute myeloid leukemia

“… 1 Notably, relapse and drug resistance are the biggest challenges facing AML therapy, with relapse rates of leukemia (including allo‐HSCT) of up to 40%–50% in all age groups. 2 , 3 New drug venetoclax shows high remission rates, but has a short‐lived effect, is resistant, and eventually leads to refractory relapses. 4 Therefore, more research and exploration are still needed to overcome the above problems.…”