Clinical impact of NPM1-mutant molecular persistence after chemotherapy for acute myeloid leukemia

Ing S. Tiong, Richard Dillon, Adam Ivey, James A. Kuzich, Nisha Thiagarajah, Kirsty M. Sharplin, Chung Hoow Kok, Aditya Tedjaseputra, James P. Rowland, Carolyn S. Grove, Emad Abro, Jake Shortt, Devendra K. Hiwase, Ashish Bajel, Nicola E. Potter, Matthew L. Smith, Claire J. Hemmaway, Abin Thomas, Amanda F. Gilkes, Nigel H. RussellAndrew H. Wei*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

21 Citations (Scopus)


Monitoring of NPM1 mutant (NPM1mut) measurable residual disease (MRD) in acute myeloid leukemia (AML) has an established role in patients who are treated with intensive chemotherapy. The European LeukemiaNet has defined molecular persistence at low copy number (MP-LCN) as an MRD transcript level ,1% to 2% with a ,1-log change between any 2 positive samples collected after the end of treatment (EOT). Because the clinical impact of MP-LCN is unknown, we sought to characterize outcomes in patients with persistent NPM1mut MRD after EOT and identify factors associated with disease progression. Consecutive patients with newly diagnosed NPM1mut AML who received $2 cycles of intensive chemotherapy were included if bone marrow was NPM1mut MRD positive at the EOT, and they were not transplanted in first complete remission. One hundred patients were followed for a median of 23.5 months; 42% remained free of progression at 1 year, either spontaneously achieving complete molecular remission (CRMRD2; 30%) or retaining a low-level NPM1mut transcript (12% for $12 months and 9% at last follow-up). Forty percent met the criteria for MP-LCN. Preemptive salvage therapy significantly prolonged relapse-free survival. Risk factors associated with disease progression were concurrent FLT3-internal tandem duplication at diagnosis and suboptimal MRD response (NPM1mut reduction ,4.4-log) at EOT.

Original languageEnglish
Pages (from-to)5107-5111
Number of pages5
JournalBlood Advances
Publication statusPublished - 14 Dec 2021


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