Quantitative monitoring of minimal residual disease in childhood acute lymphoblastic leukemia usingfusion transcript as a marker

Importance: By demonstrating withTEL-AML1, this study indicated that mRNAs transcribed from fusion genes are ideal targets for minimal residual disease (MRD) monitoring in childhood acute lymphoblastic leukemia, and that different thresholds are needed to apply them into the risk stratification.Objective: TEL-AML1 expression was measured at three time points to 1) determine cut-off values for predicting acute lymphoblastic leukemia (ALL) relapse; 2) investigate the prognostic value of this method and how well the results at these time points correlated; 3) determine the correlation between MRD levels assessed using this marker and that determined by immunoglobulin/T-cell receptor (Ig/TCR) rearrangement detection.Methods: TEL-AML1 expression in 62 children with ALL was quantitated by real-time quantitative PCR at day 15, day 33, and month 3. The relationship between patient outcome andTEL-AML1 level was analyzed at each time point. The correlation between the MRD levels determined byTEL-AML1 or Ig/TCR rearrangements was also analyzed.Results: For day 33, 6.68TEL-AML1 copies/104ABL copies was determined to be the best cut-off value. Higher levels were correlated with relapse (P = 0.001). For day 15 and month 3, the best cut-off values were 336.5 and 0.85 copies/104ABL copies respectively; patients with higher expression levels had lower RFSs (day 15:P = 0.027; month 3:P = 0.023). For days 15 and 33, MRD levels assessed usingTEL-AML1 or Ig/TCR rearrangements were strongly correlated [Spearman rank correlation?coefficient?(ρ) = 0.729 (day 15), 0.719 (day 33);P < 0.001 (both)], and both methods were equally effective at predicting relapse. At month 3, there was moderate correlation between the results derived from the two markers (ρ = 0.418,P = 0.003); however, receiver operating characteristic curve analysis showed thatTEL-AML1 was a better prognostic marker.Interpretation: TEL-AML1 is an effective marker for MRD assessment and relapse prediction in children with ALL.