Mutation tracking after chemotherapy linked to longer remission in leukemia patients
A phase two trial enrolled 100 adults aged 18 to 60 with intermediate risk acute myeloid leukemia who achieved complete remission or complete remission with incomplete count recovery after induction therapy. Doctors used whole exome sequencing to find somatic mutations at diagnosis, then tracked whether those mutations disappeared in bone marrow samples taken during remission. They set a variant allele frequency cutoff of less than 2.5 percent to define clearance. Thirty-three patients who cleared all mutations and received high dose cytarabine consolidation had a median relapse free survival of 33.1 months. That compared to 11.7 months in 239 historical controls with intermediate risk acute myeloid leukemia who received high dose cytarabine based regimens in first complete remission. The difference had a p value of 0.015, which did not meet the prespecified threshold of 0.01 because of an unplanned interim assessment. Patients with persistent mutations, defined as variant allele frequency of 2.5 percent or higher, were recommended to undergo allogeneic hematopoietic cell transplant.
Tracking whether leukemia mutations disappear after initial treatment may help doctors decide which patients can safely receive chemotherapy alone and which need a bone marrow transplant. The result sets the stage for a randomized trial.
Written by the Genomes desk from the primary source linked above and checked against it. Research use only; not medical advice. Corrections: [email protected].