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<p>Although acute myeloid leukemia (AML) with <i>CBFB::MYH11</i> rearrangement is classified as favorable-risk, approximately 40% of patients experience relapse. We evaluated the prognostic impact of <i>CBFB::MYH11</i> transcript levels and the optimal timing of allogeneic hematopoietic cell transplantation (allo-HCT) at first complete remission (CR1). A total of 186 patients with <i>CBFB::MYH11</i>-rearranged AML treated with intensive induction chemotherapy were included. <i>CBFB::MYH11</i> levels after cycles 2 and 3 were strongly correlated (<i>P</i> &lt; 0.001). The post-cycle 2 <i>CBFB::MYH11</i> transcript level emerged as the strongest prognostic marker for both disease-free survival (DFS) and overall survival (OS), outperforming assessments after cycles 1 or 3. <i>CBFB::MYH11</i> ≥ 1% after cycle 2 was independently associated with inferior DFS (HR 3.84, <i>P</i> &lt; 0.001) and OS (HR 3.98, <i>P</i> = 0.003). Among patients with post-cycle 2 <i>CBFB::MYH11</i> ≥ 1.0%, the 3-year DFS and OS were both 91.7% in patients who received allo-HCT at CR1, compared with 47.8% and 72.9%, respectively, in the chemotherapy consolidation group. Multivariate analysis indicated that allo-HCT in CR1 improved 3-year DFS compared with chemotherapy consolidation (HR 0.24; <i>P</i> = 0.023). However, no significant improvement in OS was observed during follow-up. These findings suggest that post-cycle 2 <i>CBFB::MYH11</i> level ≥1.0% identifies a high-risk subgroup that may benefit from allo-HCT in CR1.</p>

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CBFB::MYH11 MRD after the second chemotherapy cycle: a guide for allogeneic transplantation in favorable-risk AML

  • 期刊论文

  • 发表日期：

    2026年5月14日

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  • Mingyang Wang,
  • Guangji Zhang,
  • Wenwen Guo,
  • Haixiao Zhang,
  • Jiaxin Cao,
  • Jieya Luo,
  • Miao Yang,
  • Yigeng Cao,
  • Fengjiao Wang,
  • Rongli Zhang,
  • Xin Chen,
  • Weihua Zhai,
  • Qiaoling Ma,
  • Jialin Wei,
  • Donglin Yang,
  • Yi He,
  • Aiming Pang,
  • Sizhou Feng,
  • Mingzhe Han,
  • Yingchang Mi,
  • Jianxiang Wang,
  • Hui Wei,
  • Erlie Jiang

摘要

Although acute myeloid leukemia (AML) with CBFB::MYH11 rearrangement is classified as favorable-risk, approximately 40% of patients experience relapse. We evaluated the prognostic impact of CBFB::MYH11 transcript levels and the optimal timing of allogeneic hematopoietic cell transplantation (allo-HCT) at first complete remission (CR1). A total of 186 patients with CBFB::MYH11-rearranged AML treated with intensive induction chemotherapy were included. CBFB::MYH11 levels after cycles 2 and 3 were strongly correlated (P < 0.001). The post-cycle 2 CBFB::MYH11 transcript level emerged as the strongest prognostic marker for both disease-free survival (DFS) and overall survival (OS), outperforming assessments after cycles 1 or 3. CBFB::MYH11 ≥ 1% after cycle 2 was independently associated with inferior DFS (HR 3.84, P < 0.001) and OS (HR 3.98, P = 0.003). Among patients with post-cycle 2 CBFB::MYH11 ≥ 1.0%, the 3-year DFS and OS were both 91.7% in patients who received allo-HCT at CR1, compared with 47.8% and 72.9%, respectively, in the chemotherapy consolidation group. Multivariate analysis indicated that allo-HCT in CR1 improved 3-year DFS compared with chemotherapy consolidation (HR 0.24; P = 0.023). However, no significant improvement in OS was observed during follow-up. These findings suggest that post-cycle 2 CBFB::MYH11 level ≥1.0% identifies a high-risk subgroup that may benefit from allo-HCT in CR1.