医学
微小残留病
危险系数
内科学
耐火材料(行星科学)
急性淋巴细胞白血病
胃肠病学
置信区间
急性白血病
肿瘤科
卡奇霉素
白血病
淋巴细胞白血病
天体生物学
物理
作者
Elias Jabbour,Nicola Gökbuget,Anjali S. Advani,Matthias Stelljes,Wendy Stock,Michaela Liedtke,Giovanni Martinelli,Susan O'Brien,Tao Wang,A. Douglas Laird,Erik Vandendries,Alexander Neuhof,Kevin Nguyen,Naveen Dakappagari,Daniel J. DeAngelo,Hagop M. Kantarjian
标识
DOI:10.1016/j.leukres.2019.106283
摘要
Minimal residual disease (MRD) negativity is a key prognostic indicator of outcome in acute lymphocytic leukemia. In the INO-VATE trial (clinicaltrials.gov identifier: NCT01564784), patients with relapsed/refractory acute lymphocytic leukemia who received inotuzumab versus standard chemotherapy achieved greater remission and MRD-negativity rates as well as improved overall survival: hazard ratio 0.75, one-sided P = 0.0105. The current analysis assessed the prognostic value of MRD negativity at the end of inotuzumab treatment. All patients who received inotuzumab (n = 164) were included. Among patients with complete remission/complete remission with incomplete hematologic response (CR/CRi; n = 121), MRD-negative status (by multiparametric flow cytometry) was defined as <1 × 10-4 blasts/nucleated cells. MRD negativity was achieved in 76 patients at the end of treatment. Compared with MRD-positive, MRD-negative status with CR/CRi was associated with significantly improved overall survival and progression-free survival, respectively: hazard ratio (97.5% confidence interval; one-sided P-value) 0.512 (97.5% CI [0.313-0.835]; P = 0.0009) and 0.423 (97.5% CI [0.256-0.699]; P < 0.0001). Median overall survival was 14.1 versus 7.2 months, in the MRD-negative versus MRD-positive groups. Patients in first salvage who achieved MRD negativity at the end of treatment experienced significantly improved survival versus that seen in MRD-positive patients, particularly for those patients who proceeded to stem cell transplant. Among patients with relapsed/refractory acute lymphocytic leukemia who received inotuzumab, those with MRD-negative CR/CRi had the best survival outcomes.
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