CNS Relapse in AML Patients: Clinical, Molecular Predictors Identified

A recent study showed that FLT3-internal tandem duplication (ITD) mutations and elevated lactate dehydrogenase (LDH) are predictors of central nervous system (CNS) relapse in patients with acute myeloid leukemia (AML). The presence of baseline adverse features can also raise the risk of CNS relapse in this patient population.

Although CNS relapse is uncommon in patients with AML receiving prophylactic CNS therapy, the predictors associated with a higher risk of CNS leukemia relapse are not well known.
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To explore this relationship further, the researchers assessed the incidence and outcome of CNS relapses in 1245 patients with relapsed or refractory AML being treated at 1 institution from 2000 to 2014. A multivariate regression model was used, and results were adjusted for age.

Results indicated that 51 (4.1%) patients had experienced CNS leukemia relapse. The researchers found that FLT3-ITD mutation and elevated LDH of more than 1000 IU/L were independent predictive factors for CNS relapse.

Patients younger than age 64 years who had no baseline adverse features had a 3.8% probability for developing CNS, whereas patients with 1 baseline adverse feature had a 7% to 8% increased risk, and those with 2 baseline adverse features had a 13.9% increased risk.

“Our study identifies patients with AML at higher risk for CNS relapse in whom prophylactic CNS therapy may be warranted,” the researchers concluded.

—Christina Vogt

Reference:

Jabbour E, Daver NG, Short NJ, et al. Factors associated with risk of central nervous system relapse in patients with non-core binding factor acute myeloid leukemia. Am J Hematol. 2017;92(9):924-928. doi:10.1002/ajh.24799.