The level of residual disease based on mutant NPM1 is an independent prognostic factor for relapse and survival in AML

Mutations of the NPM1 gene ( NPM1 mut ) are among the most common genetic alterations in acute myeloid leukemia and are suitable for minimal residual disease detection. We retrospectively investigated the prognostic impact of NPM1 mut -based minimal residual disease detection from bone marrow for development of relapse by using a newly developed real-time polymerase chain reaction based on locked nucleic acid–containing primers in 174 patients, 155 of whom were treated within prospective protocols. The prognostic value of 5 cutoff values after completion of treatment or after allogeneic transplantation was studied by using cause-specific hazard models. Subsequent validation using cross-validated partial likelihood analysis revealed that an increase of more than 1% NPM1 mut /ABL1 was most prognostic for relapse after chemotherapy, whereas an increase of more than 10% NPM1 mut /ABL1 was most prognostic for relapse after allogeneic transplantation. Univariate and multivariate analysis of disease-free survival and overall survival revealed a significantly worse outcome in patients with >1% NPM1 mut /ABL1 and >10% NPM1 mut /ABL1, respectively, which remained significant after adjustment for FLT3 –internal tandem duplication status. Our results in a large data set define and optimize cutoff values for early diagnosis of molecular relapse. These results may be especially important for defining triggers for early therapeutic intervention.