Abstract
Cytogenetics and European Leukemia Net (ELN) genetic classification predict patients at increased risk of relapse in acute myeloid leukemia (AML) except in the intermediate risk group for which further prognostic determinants are required. We have previously shown that Natural Killer (NK) cell defects in AML are predictors of poor overall survival (OS). This study aimins at validating NKp30, a receptor that mediates NK activation, as a prognostic biomarker for AML patients with intermediate prognosis.NKp30 expression was prospectively assessed at diagnosis on NK cells from peripheral blood by flow cytometry (N = 201 patients). Clinical outcome was evaluated with regard to NKp30 status.In patients with intermediate cytogenetic (N = 162), NKp30high phenotype at diagnosis was predictive of better OS (HR = 0.26; 95%CI = [0.14-0.50]; P < 0.0001) and relapse-free survival (RFS) (HR = 0.21; 95%CI = [0.08-0.52]; P = 0.0007). In patients with intermediate ELN (N = 116), NKp30high phenotype at diagnosis was predictive of better OS (HR = 0.33; 95%CI = [0.16–0.67]; P = 0.0019) and RFS (HR = 0.24; 95%CI = [0.08-0.67]; P = 0.0058). In multivariate analysis, high NKp30 expression independently predicted improved OS (HR = 0.56, P = 0.046) and RFS (HR = 0.37, P = 0.048). Consistently, cumulative incidence of relapse (CIR) was lower in patients with high NKp30 expression (HR = 0.37, P = 0.026).In conclusion, we propose NKp30 status as a simple and early prognostic biomarker that identifies intermediate-risk patients with poor prognosis who otherwise may not be identified with existing risk stratification systems.
Highlights
Patient stratification at diagnosis for acute myeloid leukemia (AML) is crucial for clinical decision making regarding post-remission therapy
Baseline NKp30 expression on Natural Killer (NK) cells was assessed by flow cytometry
The frequency of patients with NKp30high and NKp30low phenotype did not differ between age, cytogenetics number of inductions, sex or post remission therapy
Summary
Patient stratification at diagnosis for acute myeloid leukemia (AML) is crucial for clinical decision making regarding post-remission therapy. Patient stratification is based on cytogenetics and molecular classifications [1, 2]. As proposed by the ELN genetic classification based on FLT3/CEBPα/NPM1 mutational status further refines patient stratification, but clinical uncertainty remains with an unclassifiable group of patients with intermediate prognosis [3, 4]. Molecular markers do not account for the entire prognostic heterogeneity of AML and new markers are warranted. In this context, accurate estimation of the risk of relapse at diagnosis or after complete remission (CR) in patients with intermediate prognosis is essential for physicians in order to evaluate the potential benefits of intensive chemotherapy and allogeneic stem cell transplantation (allo-SCT)
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