Prognostic value of measuring LSC frequency in AML: a systematic review and meta-analysis.
Tom Reuvekamp, Marry Lin, Lok Lam Ngai et al.
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In 30 seconds
This systematic review and reconstructed individual patient data meta-analysis assessed whether leukemia stem cell (LSC) measurements predict outcomes in patients with acute myeloid leukemia at diagnosis or in remission. It included 56 studies, with outcome data from multiple cohorts at both time points. Positive LSC status was associated with inferior overall and event-free survival: at diagnosis, the hazard ratios were 1.96 for overall survival and 2.32 for event-free survival; in remission, they were 2.59 and 2.53, respectively. The authors conclude that LSC measurement has prognostic relevance at both stages.
Key findings
- At diagnosis, positive LSC status was associated with inferior overall survival (HR, 1.96; 95% CI, 1.85-2.08) and event-free survival (HR, 2.32; 95% CI, 2.15-2.49).
- In remission, positive LSC status was associated with inferior overall survival (HR, 2.59; 95% CI, 2.23-3.03) and event-free survival (HR, 2.53; 95% CI, 2.18-2.94).
- The analysis included 56 studies; diagnosis-time analyses covered 7781 patients for overall survival and 5032 for event-free survival.
Why it matters
The consistent association between positive LSC status and poorer survival at diagnosis and in remission suggests that LSC measurement may add prognostic information across disease stages. This could help inform risk assessment and residual-disease evaluation, although the meta-analysis establishes prognostic association rather than showing that LSC-guided decisions improve outcomes.
What to keep in mind
The analysis reconstructed individual patient data from published Kaplan-Meier curves, rather than using original patient-level data.