Detectable minimal residual disease before hematopoietic cell transplantation is prognostic but does not preclude cure for children with very-high-risk leukemia

Author:

Leung Wing12,Pui Ching-Hon234,Coustan-Smith Elaine3,Yang Jie5,Pei Deqing5,Gan Kwan1,Srinivasan Ashok12,Hartford Christine1,Triplett Brandon M.12,Dallas Mari12,Pillai Asha12,Shook David12,Rubnitz Jeffrey E.23,Sandlund John T.23,Jeha Sima23,Inaba Hiroto23,Ribeiro Raul C.23,Handgretinger Rupert23,Laver Joseph H.12,Campana Dario23

Affiliation:

1. Department of Bone Marrow Transplantation and Cellular Therapy, St Jude Children's Research Hospital, Memphis, TN;

2. Department of Pediatrics, University of Tennessee Health Science Center, College of Medicine, Memphis, TN; and

3. Departments of Oncology,

4. Pathology, and

5. Biostatistics, St Jude Children's Research Hospital, Memphis, TN

Abstract

Abstract In patients with acute leukemia, detection of minimal residual disease (MRD) before allogeneic hematopoietic cell transplantation (HCT) correlates with risk of relapse. However, the level of MRD that is most likely to preclude cure by HCT is unclear, and the benefit of further chemotherapy to reduce MRD before HCT is unknown. In 122 children with very-high-risk acute lymphoblastic leukemia (ALL; n = 64) or acute myeloid leukemia (AML, n = 58), higher MRD levels at the time of HCT predicted a poorer survival after HCT (P = .0019); MRD was an independent prognostic factor in a multivariate analysis (P = .0035). However, the increase in risk of death associated with a similar increment of MRD was greater in ALL than in AML, suggesting that a pretransplantation reduction of leukemia burden would have a higher impact in ALL. At any given MRD level, survival rates were higher for patients treated in recent protocols: the 5-year overall survival for patients with ALL was 49% if MRD was detectable and 88% if it was not and the corresponding rates for patients with AML were 67% and 80%, respectively. Although MRD before HCT is a strong prognostic factor, its impact has diminished and should not be regarded as a contraindication for HCT.

Publisher

American Society of Hematology

Subject

Cell Biology,Hematology,Immunology,Biochemistry

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