Allogeneic Hematopoietic Cell Transplantation for XXXX : Time to Move Toward a Minimal Residual Disease-Based Definition of Complete Remission?

@entity1 @entity66 @entity41 @entity3052
PURPOSE: @entity1 with @entity3052 ( @entity3052 ) who are in morphologic complete remission are typically considered separately from @entity1 with @entity66 (ie, >=  5% marrow blasts by morphology) in treatment algorithms for allogeneic hematopoietic cell transplantation (HCT), which implies distinct outcomes for these two groups. It is well recognized that the presence of @entity41 ( @entity41 ) at the time of transplantation is associated with adverse post-HCT outcome for those @entity1 in morphologic remission. This effect of pre-HCT @entity41 prompted us to compare outcomes in consecutive @entity1 in @entity41 -positive remission with @entity1 with active @entity3052 who underwent myeloablative allogeneic HCT at our institution. @entity1 AND METHODS: We retrospectively studied 359 consecutive adults with @entity3052 who underwent myeloablative allogeneic HCT from a peripheral blood or bone marrow donor between 2006 and 2014. Pre-HCT disease staging included 10-color multiparametric flow cytometry on bone marrow aspirates in all @entity1 . Any level of @entity66 was considered to be @entity41 positive. RESULTS: Three-year relapse estimates were 67% in 76 @entity1 in @entity41 and 65% in 48 @entity1 with active @entity3052 compared with 22% in 235 @entity1 in @entity41 -negative remission. Three-year overall survival estimates were 26%, 23%, and 73% in these three groups, respectively. After multivariable adjustment, @entity41 -negative remission status remained statistically significantly associated with longer overall and progression-free survival as well as lower risk of relapse compared with @entity41 status or having @entity66 , with similar outcomes between the latter two groups. CONCLUSION: The similarities in outcomes between @entity1 in @entity41 and those with @entity66 at the time of HCT support the use of treatment algorithms that use @entity41 - rather than morphology-based disease assessments.
