We found a match
Your institution may have rights to this item. Sign in to continue.
- Title
Persistent MRD before and after allogeneic BMT predicts relapse in children with acute lymphoblastic leukaemia.
- Authors
Sutton, Rosemary; Shaw, Peter J.; Venn, Nicola C.; Law, Tamara; Dissanayake, Anuruddhika; Kilo, Tatjana; Haber, Michelle; Norris, Murray D.; Fraser, Chris; Alvaro, Frank; Revesz, Tamas; Trahair, Toby N.; Dalla‐Pozza, Luciano; Marshall, Glenn M.; O'Brien, Tracey A.
- Abstract
Minimal residual disease ( MRD) during early chemotherapy is a powerful predictor of relapse in acute lymphoblastic leukaemia ( ALL) and is used in children to determine eligibility for allogeneic haematopoietic stem cell transplantation ( HSCT) in first ( CR1) or later complete remission ( CR2/ CR3). Variables affecting HSCT outcome were analysed in 81 children from the ANZCHOG ALL8 trial. The major cause of treatment failure was relapse, with a cumulative incidence of relapse at 5 years ( CIR) of 32% and treatment-related mortality of 8%. Leukaemia-free survival ( LFS) and overall survival ( OS) were similar for HSCT in CR1 ( LFS 62%, OS 83%, n = 41) or CR2/ CR3 ( LFS 60%, OS 72%, n = 40). Patients achieving bone marrow MRD negativity pre- HSCT had better outcomes ( LFS 83%, OS 92%) than those with persistent MRD pre- HSCT ( LFS 41%, OS 64%, P < 0·0001) or post- HSCT ( LFS 35%, OS 55%, P < 0·0001). Patients with B-other ALL had more relapses ( CIR 50%, LFS 41%) than T- ALL and the main precursor-B subtypes including BCR- ABL1, KMT2A ( MLL), ETV6- RUNX1 ( TEL- AML1) and hyperdiploidy >50. A Cox multivariate regression model for LFS retained both B-other ALL subtype (hazard ratio 4·1, P = 0·0062) and MRD persistence post- HSCT (hazard ratio 3·9, P = 0·0070) as independent adverse prognostic variables. Persistent MRD could be used to direct post- HSCT therapy.
- Subjects
CANCER chemotherapy; LYMPHOBLASTIC leukemia treatment; LYMPHOBLASTIC leukemia; CANCER relapse; STEM cell transplantation; PATIENTS
- Publication
British Journal of Haematology, 2015, Vol 168, Issue 3, p395
- ISSN
0007-1048
- Publication type
Article
- DOI
10.1111/bjh.13142