Persistent MRD before and after allogeneic BMT predicts relapse in children with acute lymphoblastic leukaemia

被引：62

作者：

Sutton, Rosemary ^{[1
]}

Shaw, Peter J. ^{[2
]}

Venn, Nicola C. ^{[1
]}

Law, Tamara ^{[1
]}

Dissanayake, Anuruddhika ^{[1
]}

Kilo, Tatjana ^{[2
]}

Haber, Michelle ^{[1
]}

Norris, Murray D. ^{[1
]}

Fraser, Chris ^{[3
]}

Alvaro, Frank ^{[4
]}

Revesz, Tamas ^{[5
]}

Trahair, Toby N. ^{[1
,6
]}

Dalla-Pozza, Luciano ^{[2
]}

Marshall, Glenn M. ^{[1
,6
]}

O'Brien, Tracey A. ^{[1
,6
]}

机构：

[1] UNSW, Lowy Canc Res Ctr, Childrens Canc Inst Australia, Randwick, NSW, Australia

[2] Childrens Hosp Westmead, Oncol Unit, Westmead, NSW, Australia

[3] Royal Childrens Hosp, Brisbane, Qld, Australia

[4] John Hunter Childrens Hosp, Newcastle, NSW, Australia

[5] Women & Childrens Hosp, Adelaide, SA, Australia

[6] Sydney Childrens Hosp, Kids Canc Ctr, Randwick, NSW, Australia

来源：

BRITISH JOURNAL OF HAEMATOLOGY | 2015年 / 168卷 / 03期

基金：

澳大利亚国家健康与医学研究理事会;

关键词：

acute lymphoblastic leukaemia; minimal residual disease; bone marrow transplantation; IKZF1; childhood leukaemia; MINIMAL RESIDUAL DISEASE; STEM-CELL TRANSPLANTATION; RECEPTOR GENE REARRANGEMENTS; BONE-MARROW-TRANSPLANTATION; CLINICAL-SIGNIFICANCE; PROGNOSTIC-FACTORS; HEMATOPOIETIC SCT; IMMUNOGLOBULIN; CHEMOTHERAPY; THERAPY;

D O I：

10.1111/bjh.13142

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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 5years (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<00001) or post-HSCT (LFS 35%, OS 55%, P<00001). 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 41, P=00062) and MRD persistence post-HSCT (hazard ratio 39, P=00070) as independent adverse prognostic variables. Persistent MRD could be used to direct post-HSCT therapy.

引用

页码：395 / 404

页数：10

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