Patients with acute myeloid leukemia (AML) who achieve cytogenetic remission may have better survival outcomes than patients with new or sustained cytogenetic abnormalities, according to findings from a study published in the American Journal of Hematology.
The study elucidated how cytogenetic responses from treatment have a significant impact on survival for patients with AML.
“Clinicians often monitor minimal residual disease, but it’s hard to make meaningful conclusions from these measurements in patients with AML,” stated study senior author Moaath K. Mustafa Ali, MD, Medical Oncologist at Cleveland Clinic Cancer Institute. “Understanding the implications of persistence or changes in cytogenetic abnormalities at the time of response would allow for a more comprehensive assessment.”
Background and Study Methods
Previously, cytogenetic analysis for patients with AML has not focused on baseline analysis to assess changes, but has instead focused only on a binary assessment of normal or abnormal cytogenetics after treatment. Researchers sought to gain a greater understanding of the prognostic implications of cytogenetic changes from baseline for patients with AML.
The researchers looked at baseline and post-treatment cytogenetic data and response assessments from 563 adult patients with AML treated at Cleveland Clinic between May 2017 and September 2023. Patients were categorized by their baseline and response cytogenetic status:
- Normal to normal (39%)
- Normal or abnormal to abnormality gain (8.2%)
- Abnormal to persistent abnormality (14%)
- Abnormal to partial response (3.6%)
- Abnormal to complete response (35%).
“We changed the classification from qualitative to quantitative to account for variations in response,” explained study author Caroline Astbury, PhD, FACMG, Director of Molecular Pathology & Cytogenomics at Cleveland Clinic Cancer Institute.
Key Study Findings
Patients were followed for a median of 45.8 months (range = 0.73–191.3 months). From multivariable regression analysis, median overall survivals by cytogenetic change categories were:
- Normal to normal: 37 months (95% confidence interval [CI] = 27–91 months)
- Normal or abnormal to abnormality gain: 14 months (95% CI = 8.6–30 months); hazard ratio (HR) = 1.5 (95% CI = 0.99–2.39)
- Abnormal to persistent abnormality: 13 months (95% CI = 12–18 months); HR = 1.61 (95% CI = 1.13–2.31)
- Abnormal to partial response: 25 months (95% CI = 14 months to not calculable); HR = 0.76 (95% CI = 0.39–1.49)
- Abnormal to complete response: 27 months (95% CI = 19–101 months); HR = 1.25 (95% CI = 0.93–1.68); P = .038.
Overall, achieving a complete or partial cytogenetic remission was associated with better survival outcomes than a new or persistent cytogenetic abnormality.
“This analysis shows that patients with a partial cytogenetic response may not have increased risk of mortality or refractory disease. In fact, their prognosis is similar to those with a complete cytogenetic remission,” Dr. Mustafa Ali said. “In my opinion, the persistence or gain of cytogenetic abnormalities is generally a sign to change to a regimen with a different mechanism of action.”
The study authors suggested that the monitoring of cytogenetic response could inform treatment decisions for patients with AML and that their findings could support the integration of cytogenetic response into a risk-adapted strategy for the personalized treatment management of patients with AML.
Disclosure: For full disclosures of the study authors, visit onlinelibrary.wiley.com.
