In:
British Journal of Haematology, Wiley, Vol. 168, No. 3 ( 2015-02), p. 395-404
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 ( CR 1) or later complete remission ( CR 2/ CR 3). Variables affecting HSCT outcome were analysed in 81 children from the ANZCHOG ALL 8 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 CR 1 ( LFS 62%, OS 83%, n = 41) or CR 2/ CR 3 ( 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 ‐ ABL 1 , KMT 2A ( MLL ), ETV 6 ‐ RUNX 1 ( TEL ‐ AML 1 ) 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.
Type of Medium:
Online Resource
ISSN:
0007-1048
,
1365-2141
DOI:
10.1111/bjh.2015.168.issue-3
Language:
English
Publisher:
Wiley
Publication Date:
2015
detail.hit.zdb_id:
1475751-5
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