Differential response to cytotoxic therapy explains treatment dynamics of acute myeloid leukaemia patients: Insights from a mathematical modelling approach: Differential response to cytotoxic therapy explains treatment dynamics of acute myeloid leukaemia patients: Insights from a mathematical modelling approach

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Abstract

Disease response and durability of remission are very heterogeneous in patients with acute myeloid leukaemia (AML). There is increasing evidence that the individual risk of early relapse can be predicted based on the initial treatment response. However, it is unclear how such a correlation is linked to functional aspects of AML progression and treatment. We suggest a mathematical model in which leukaemia-initiating cells and normal/healthy haematopoietic stem and progenitor cells reversibly change between an active state characterized by proliferation and chemosensitivity and a quiescent state, in which the cells do not divide, but are also insensitive to chemotherapy. Applying this model to 275 molecular time courses of nucleophosmin 1-mutated patients, we conclude that the differential chemosensitivity of the leukaemia-initiating cells together with the cells' intrinsic proliferative capacity is sufficient to reproduce both, early relapse as well as long-lasting remission. We can, furthermore, show that the model parameters associated with individual chemosensitivity and proliferative advantage of the leukaemic cells are closely linked to the patients' time to relapse, while a reliable prediction based on early response only is not possible based on the currently available data. Although we demonstrate with our approach, that the complete response data is sufficient to quantify the aggressiveness of the disease, further investigations are necessary to study how an intensive early sampling strategy may prospectively improve risk assessment and help to optimize individual treatments.

Details

Original languageEnglish
Article number20200091
JournalJournal of the Royal Society interface
Volume17
Issue number170
Publication statusPublished - 1 Sept 2020
Peer-reviewedYes

External IDs

PubMed 32900301
ORCID /0000-0002-2524-1199/work/153110193

Keywords

Keywords

  • acute myeloid leukaemia, leukaemia, mathematical modelling, measurable residual disease, relapse prediction, risk stratification