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Minimal residual disease level predicts outcome in adults with Ph-negative B-precursor acute lymphoblastic leukemia.
- Source :
- Hematology; Dec2019, Vol. 24 Issue 1, p337-348, 12p
- Publication Year :
- 2019
-
Abstract
- Objectives: Detectable minimal residual disease (MRD) after therapy for acute lymphoblastic leukemia (ALL) is the strongest predictor of hematologic relapse. This study evaluated outcomes of patients with B-cell precursor ALL with MRD of ≥10<superscript>−4</superscript> Methods: Study population was from ALL study groups in Europe managed in national study protocols 2000–2014. MRD was measured by polymerase chain reaction or flow cytometry. Patients were age ≥15 years at initial ALL diagnosis. Patients were excluded if exposed to blinatumomab within 18 months of baseline or prior alloHSCT. Results: Of 272 patients in CR1, baseline MRD was ≥10<superscript>−1</superscript>, 10<superscript>−2</superscript> to <10<superscript>−1</superscript>, 10<superscript>−3</superscript> to <10<superscript>−2</superscript>, and 10<superscript>−4</superscript> to <10<superscript>−3</superscript> in 15 (6%), 71 (26%), 109 (40%), and 77 (28%) patients, respectively. Median duration of complete remission (DoR) was 18.5 months (95% confidence interval [CI], 11.9–27.2), median relapse-free survival (RFS) was 12.4 months (95% CI, 10.0–19.0) and median overall survival (OS) was 32.5 months (95% CI, 23.6–48.0). Lower baseline MRD level (P ≤.0003) and white blood cell count <30,000/µL at diagnosis (P ≤.0053) were strong predictors for better RFS and DoR. Allogeneic hematopoietic stem cell transplantation (alloHSCT) was associated with longer RFS (hazard ratio [HR], 0.59; 95% CI, 0.41–0.84) and DoR (HR, 0.43; 95% CI, 0.29–0.64); the association with OS was not significant (HR, 0.72; 95% CI, 0.50–1.05). Discussion: In conclusion, RFS, DoR, and OS are relatively short in patients with MRD-positive ALL, particularly at higher MRD levels. AlloHSCT may improve survival but has limitations. Alternative approaches are needed to improve outcomes in MRD-positive ALL. [ABSTRACT FROM AUTHOR]
Details
- Language :
- English
- ISSN :
- 10245332
- Volume :
- 24
- Issue :
- 1
- Database :
- Complementary Index
- Journal :
- Hematology
- Publication Type :
- Academic Journal
- Accession number :
- 140069179
- Full Text :
- https://doi.org/10.1080/16078454.2019.1567654