Log reduction of leukemic cells and minimal residual disease by flow cytometry represent effective predictors of clinical outcome in elderly patients with acute myeloid leukemia

Background Nowadays minimal residual disease (MRD) and log-reduction of leukemic cells are poorly investigated in elderly patients with acute myeloid leukemia (AML) treated with hypometilating agents (HMAs). Studies focusing on MRD in elderly AML patients who received HMAs are scant and devoid of rigorous criteria for both enrollment and monitoring. Log-reduction has never been investigated in these patients. Thus, the purpose of our study was to compare the prognostic impact of MRD and log-reduction of leukemic cells at the optimal time of assessment in older AML patients. Methods Elderly patients who completed at least six cycles of HMAs and showed suitable leukemia-associated immunophenotypes (LAIPs) for the MRD and log-reduction assessment by flow cytometry were enrolled in the study. Results After comparing the times of assessment C4 (4-cycles) and C6 (6-cycles), C6 has been chosen as optimal. Patients who achieved MRD negativity or 2-log-reduction of leukemic cells at C6 had a significantly longer DFS. Particularly, results of 2-log-reduction were confirmed a multivariate analysis. Patients with MRD negativity or 2-log reduction of leukemic cells showed an improvement of their OS, although not significantly. Conclusions Our data confirmed the predictive role of MRD and 2-log reduction also in older AML patients treated with HMAs.

Automated summary

Research on minimal residual disease (MRD) and log-reduction of leukemic cells in elderly acute myeloid leukemia (AML) patients treated with hypomethylating agents (HMAs) is limited. Our study found that assessment at the sixth cycle is optimal for predicting prognosis, where achieving MRD negativity or 2-log-reduction of leukemic cells significantly improves disease-free survival. These findings confirm the predictive role of MRD and 2-log reduction in older AML patients treated with HMAs.