Association Between Mutation Clearance After Induction Therapy and Outcomes in Acute Myeloid Leukemia

摘要: Importance Tests that predict outcomes for patients with acute myeloid leukemia (AML) are imprecise, especially those intermediate risk AML. Objectives To determine whether genomic approaches can provide novel prognostic information adult de novo Design, Setting, and Participants Whole-genome or exome sequencing was performed on samples obtained at disease presentation from 71 AML (mean age, 50.8 years) treated standard induction chemotherapy a single site starting in March 2002, follow-up through January 2015. In addition, deep digital paired diagnosis remission 50 (including 32 intermediate-risk AML), approximately 30 days after successful therapy. Twenty-five of the were cohort patients, 25 new, additional cases. Exposures targeted sequencing. Risk identification based genetic data. Main Outcomes Measures Mutation patterns clearance leukemia-associated variants chemotherapy) their association event-free survival overall survival. Results Analysis comprehensive data did not improve outcome assessment over current standard-of-care metrics. an analysis both documented samples, 24 (48%) had persistent mutations least 5% bone marrow cells remission. The significantly reduced vs 26 who cleared all (median [95% CI]: 6.0 months CI, 3.7-9.6] 17.9 11.3-40.4] mutations, log-rank P  = .003; HR, 2.86 1.39-5.88],  = .004). Among cytogenetic risk, 14 compared 18 8.8 3.7-14.6] 25.6 11.4-not estimable] 3.32 1.44-7.67],  = .005) 19.3 7.5-42.3] 46.8 22.6-not  = .02; 2.88 1.11-7.45],  = .03). Conclusions Relevance detection day associated increased relapse, These suggest this approach may stratification