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Table 1.  

  Patients
Characteristic n %
Full cohort, n 295 100
Recipient age, median (range) 66 (6-76)
Recipient sex    
 Female 117 40
 Male 178 60
HCT-CI score    
 0 83 28
 1-2 81 27
 3+ 120 40
 Missing 11 4
Type of AML (clinically defined)    
De novo 173 59
 Secondary 91 31
 Therapy-related 31 11
Cytogenetics*    
 Normal 136 46
 Core binding factor 6 2
 Complex karyotype 41 14
 Other 112 38
2017 ELN risk group    
 Favorable 53 18
 Intermediate 85 29
 Adverse 152 52
 Missing 5 2
Initial therapy    
 Intensive induction 249 84
 Non-intensive induction 46 16
Reinduction    
 Yes 90 31
 No 204 69
 Missing 1 0.3
Remission quality    
 CR with hematologic recovery 225 75
 CRi 67 23
 Missing 1 0.3
Donor type    
 Matched related 54 18
 Matched unrelated 154 52
 Mismatch related 7 2
 Mismatch unrelated 29 10
 Haploidentical 51 17
Conditioning regimen    
 Myeloablative 28 9
 Reduced intensity 267 91
  T-cell depletion 25 9
Stem cell source    
 Peripheral blood 216 73
 Bone marrow 71 24
 Umbilical cord blood 8 3

Table 1. Cohort characteristics

Shown are the pretransplant characteristics of the 295 patients included in the cohort. HCT-CI: hematopoietic cell transplant comorbidity index score. CRi denotes complete remission with incomplete recovery of at least 1 hematopoietic cell lineage.

ELN, European Leukemia Network.

* Core binding factor: inv(16) or t(8;21); complex karyotype: 3 or more chromosomal abnormalities within a single clone.

CME / ABIM MOC

Impact of Diagnostic Genetics on Remission MRD and Transplantation Outcomes in Older Patients With AML

  • Authors: H. Moses Murdock, MD; Haesook T. Kim, PhD; Nathan Denlinger, DO; Pankit Vachhani, MD; Bryan C. Hambley, MD, MPH; Bryan S. Manning; Shannon Gier; Christina Cho, MD; Harrison K. Tsai, MD, PhD; Shannon R. McCurdy, MD; Vincent T. Ho, MD; John Koreth, MBBS, DPhil; Robert J. Soiffer, MD; Jerome Ritz, MD; Martin P. Carroll, MD; Sumithira Vasu, MBBS; Miguel-Angel Perales, MD; Eunice S. Wang, MD; Lukasz P. Gondek, MD, PhD; Steven M. Devine, MD; Edwin P. Alyea III, MD; R. Coleman Lindsley, MD, PhD; Christopher J. Gibson, MD
  • CME / ABIM MOC Released: 6/16/2022
  • Valid for credit through: 6/16/2023
Start Activity

  • Credits Available

    Physicians - maximum of 1.00 AMA PRA Category 1 Credit(s)™

    ABIM Diplomates - maximum of 1.00 ABIM MOC points

    You Are Eligible For

    • Letter of Completion
    • ABIM MOC points

Target Audience and Goal Statement

This activity is intended for hematologists, oncologists, internists, geriatricians, and other clinicians caring for older patients with acute myeloid leukemia (AML).

The goal of this activity is that the learner will be better able to describe factors that drive outcomes of allogeneic hematopoietic cell transplantation (HCT) for AML in older patients, according to a targeted mutational genomic analysis of paired diagnostic and available remission specimens in a multi-institutional cohort of 295 patients with AML aged ≥ 60 years who underwent HCT in first complete morphologic remission (CR1).

Upon completion of this activity, participants will:

  1. Describe clinical and genetic determinants of posttransplant leukemia-free survival in older patients with acute myeloid leukemia (AML), according to a targeted mutational genomic analysis
  2. Determine molecular genetics of complete remission and minimal residual disease associations with baseline characteristics and posttransplant outcomes in older patients with AML, according to a targeted mutational genomic analysis of paired diagnostic and available remission specimens
  3. Identify clinical implications of factors that drive outcomes of allogeneic hematopoietic cell transplantation for AML in older patients, according to a targeted mutational genomic analysis of paired diagnostic and available remission specimens


Disclosures

Medscape, LLC requires every individual in a position to control educational content to disclose all financial relationships with ineligible companies that have occurred within the past 24 months. Ineligible companies are organizations whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

All relevant financial relationships for anyone with the ability to control the content of this educational activity are listed below and have been mitigated according to Medscape policies. Others involved in the planning of this activity have no relevant financial relationships.


Faculty

  • H. Moses Murdock, MD

    Division of Hematologic Neoplasia
    Department of Medical Oncology
    Dana-Farber Cancer Institute
    Boston, Massachusetts

  • Haesook T. Kim, PhD

    Department of Data Science
    Dana-Farber Cancer Institute
    Boston, Massachusetts

  • Nathan Denlinger, DO

    Division of Hematology
    The Ohio State University James Cancer Hospital
    Columbus, Ohio

  • Pankit Vachhani, MD

    Division of Hematology and Oncology
    University of Alabama at Birmingham School of Medicine

  • Bryan C. Hambley, MD, MPH

    Department of Internal Medicine
    Division of Hematology/Oncology
    University of Cincinnati
    Cincinnati, Ohio

  • Bryan S. Manning

    Department of Medicine
    Perelman Cancer Center
    University of Pennsylvania
    Philadelphia, Pennsylvania

  • Shannon Gier

    Department of Medicine
    Perelman Cancer Center
    University of Pennsylvania
    Philadelphia, Pennsylvania

  • Christina Cho, MD

    Department of Medicine
    Memorial Sloan Kettering Cancer Center
    New York, New York

  • Harrison K. Tsai, MD, PhD

    Department of Pathology
    Boston Children’s Hospital
    Harvard Medical School
    Boston, Massachusetts

  • Shannon R. McCurdy, MD

    Department of Medicine
    Perelman Cancer Center
    University of Pennsylvania
    Philadelphia, Pennsylvania

  • Vincent T. Ho, MD

    Division of Hematologic Malignancies
    Department of Medical Oncology
    Dana-Farber Cancer Institute
    Boston, Massachusetts

  • John Koreth, MBBS, DPhil

    Division of Hematologic Malignancies
    Department of Medical Oncology
    Dana-Farber Cancer Institute
    Boston, Massachusetts

  • Robert J. Soiffer, MD

    Division of Hematologic Malignancies
    Department of Medical Oncology
    Dana-Farber Cancer Institute
    Boston, Massachusetts

  • Jerome Ritz, MD

    Division of Hematologic Neoplasia
    Department of Medical Oncology
    Dana-Farber Cancer Institute
    Boston, Massachusetts

  • Martin P. Carroll, MD

    Department of Medicine
    Perelman Cancer Center
    University of Pennsylvania
    Philadelphia, Pennsylvania

  • Sumithira Vasu, MBBS

    Division of Hematology
    The Ohio State University James Cancer Hospital
    Columbus, Ohio

  • Miguel-Angel Perales, MD

    Department of Medicine
    Memorial Sloan Kettering Cancer Center
    New York, New York

  • Eunice S. Wang, MD

    Department of Medicine
    Roswell Park Comprehensive Cancer Center
    Buffalo, New York

  • Lukasz P. Gondek, MD, PhD

    Sidney Kimmel Comprehensive Cancer Center
    Johns Hopkins University
    Baltimore, Maryland

  • Steven M. Devine, MD

    National Marrow Donor Program
    Minneapolis, Minnesota

  • Edwin P. Alyea III, MD

    Duke Cancer Institute
    Duke University Medical Center
    Durham, North Carolina

  • R. Coleman Lindsley, MD, PhD

    Division of Hematologic Neoplasia
    Department of Medical Oncology
    Dana-Farber Cancer Institute
    Boston, Massachusetts

  • Christopher J. Gibson, MD

    Division of Hematologic Malignancies
    Department of Medical Oncology
    Dana-Farber Cancer Institute
    Boston, Massachusetts

CME Author

  • Laurie Barclay, MD

    Freelance writer and reviewer
    Medscape, LLC

    Disclosures

    Laurie Barclay, MD, has the following relevant financial relationships:
    Formerly owned stocks in: AbbVie

Editor

  • Hervé Dombret, MD

    Associate Editor, Blood

Compliance Reviewer

  • Amanda Jett, PharmD, BCACP

    Associate Director, Accreditation and Compliance
    Medscape, LLC

    Disclosures

    Amanda Jett, PharmD, BCACP, has no relevant financial relationships.


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In support of improving patient care, this activity has been planned and implemented by Medscape, LLC and the American Society of Hematology. Medscape, LLC is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

    For Physicians

  • Medscape, LLC designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.0 MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

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CME / ABIM MOC

Impact of Diagnostic Genetics on Remission MRD and Transplantation Outcomes in Older Patients With AML: Key Points

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Key Points

  • Transplant outcomes in older patients with AML in first remission are primarily determined by characteristics present at diagnosis.
  • MRD in older patients with AML is associated with high-risk baseline features and does not affect LFS independent of baseline risk.