Korean J Intern Med.
2023 Jul;38(4):534-545. 10.3904/kjim.2022.396.
The prognostic impact of reduced variant burden in elderly patients with acute myeloid leukemia treated with decitabine
- Kim M1
- Kim T2,3
- Ahn SY1
- Lee JH4
- Park JH5
- Shin MG5
- Jung SH1
- Song GY1
- Yang DH1
- Lee JJ1
- Choi SH6
- Kim MY6
- Ahn JS
1,6 - Kim HJ1,6
- Kim DDH7
- Affiliations
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- 1Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
- 2Department of Computer Science, University of Toronto, Toronto, Canada
- 3Donnelly Centre for Cellular and Biomolecular Research, University of Toronto, Toronto, Canada
- 4GC Labs, Yongin, Korea
- 5Department of Laboratory Medicine, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
- 6Genomic Research Center for Hematopoietic Diseases, Chonnam National University Hwasun Hospital, Hwasun, Korea
- 7Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
- KMID: 2544197
- DOI: http://doi.org/10.3904/kjim.2022.396
Abstract
- Background/Aims
We evaluated the role of next-generation sequencing (NGS)-based disease monitoring for elderly patients diagnosed with acute myeloid leukemia (AML) who received decitabine therapy.
Methods
A total of 123 patients aged > 65 years with AML who received decitabine were eligible. We analyzed the dynamics of variant allele frequency (VAF) in 49 available follow-up samples after the fourth cycle of decitabine. The 58.6% VAF clearance (Δ, [VAF at diagnosis − VAF at follow-up] × 100 / VAF at diagnosis) was the optimal cut-off for predicting overall survival (OS).
Results
The overall response rate was 34.1% (eight patients with complete remission [CR], six of CR with incomplete hematologic recovery, 22 with partial responses, and six with morphologic leukemia-free status). Responders (n = 42) had significantly better OS compared with non-responders (n = 42) (median, 15.3 months vs. 6.5 months; p < 0.001). Of the 49 patients available for follow-up targeted NGS analysis, 44 had trackable gene mutations. The median OS of patients with ΔVAF ≥ 58.6% (n=24) was significantly better than that of patients with ΔVAF < 58.6% (n = 19) (20.5 months vs. 9.8 months, p = 0.010). Moreover, responders with ΔVAF ≥ 58.6% (n = 20) had a significantly longer median OS compared with responders with VAF < 58.6% (n = 11) (22.5 months vs. 9.8 months, p = 0.004).
Conclusions
This study suggested that combining ΔVAF ≥ 58.6%, a molecular response, with morphologic and hematologic responses can more accurately predict OS in elderly AML patients after decitabine therapy.
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