Clinical value of pre-transplant minimal residual disease in childhood lymphoblastic leukaemia: the results of the French minimal residual disease-guided protocol

被引:28
作者
Gandemer, Virginie [1 ]
Pochon, Cecile [2 ]
Oger, Emmanuel [3 ]
Dalle, Jean-Hugues H. [4 ]
Michel, Gerard [5 ]
Schmitt, Claudine [2 ]
de Berranger, Eva [6 ]
Galambrun, Claire [7 ]
Cave, Helene [8 ,9 ]
Cayuela, Jean-Michel [10 ]
Grardel, Nathalie [11 ]
Macintyre, Elizabeth [12 ]
Margueritte, Genevieve [13 ]
Mechinaud, Francoise [14 ]
Rorhlich, Pierre [15 ]
Lutz, Patrick [16 ]
Demeocq, Francois [17 ]
Schneider, Pascale [18 ]
Plantaz, Dominique [19 ]
Poiree, Marilyne [20 ]
Bordigoni, Pierre [2 ]
机构
[1] Univ Hosp Rennes, Dept Paediat Haematol Oncol, Rennes, France
[2] Univ Hosp Nancy, Dept Paediat Haematol Oncol, Nancy, France
[3] Univ Hosp Rennes, Pharmacoepidemiol Team, Dept Clin Pharmacol, Rennes, France
[4] Univ Hosp Robert Debre, Dept Paediat Haematol, Paris, France
[5] Univ Hosp La Timone, Dept Paediat Haematol, Marseille, France
[6] Univ Hosp Jeanne de Flandre, Dept Paediat Haematol Oncol, Lille, France
[7] Hosp Civils Lyon, Dept Paediat Haematol, Lyon, France
[8] Univ Hosp Robert Debre, Paris, France
[9] Paris Diderot Univ, Paris, France
[10] St Louis Univ Hosp, Haematol Lab, Paris, France
[11] Univ Hosp Calmette, Haematol Lab, Lille, France
[12] Univ Hosp Necker, Haematol Lab, Paris, France
[13] Univ Hosp Villeneuve, Dept Paediat Haematol Oncol, Montpellier, France
[14] Univ Hosp Nantes, Dept Paediat Haematol Oncol, Nantes, France
[15] Univ Hosp Besancon, Dept Paediat Haematol Oncol, Besancon, France
[16] Univ Hosp Hautepierre, Dept Paediat Haematol Oncol, Strasbourg, France
[17] Univ Hosp Clermont Ferrand, Dept Paediat Haematol Oncol, Clermont Ferrand, France
[18] Univ Hosp Rouen, Dept Paediat Haematol, Rouen, France
[19] Univ Hosp La Tronche, Dept Paediat Haematol Oncol, Grenoble, France
[20] Univ Hosp Archet II, Dept Paediat Haematol Oncol, Nice, France
关键词
mrd; transplantation; childhood leukaemia; prognostic factors; STEM-CELL TRANSPLANTATION; BONE-MARROW-TRANSPLANTATION; VERSUS-HOST DISEASE; PEDIATRIC-PATIENTS; COMPLETE REMISSION; PROGNOSTIC-FACTORS; QUANTITATIVE PCR; FLOW-CYTOMETRY; CORD BLOOD; CHILDREN;
D O I
10.1111/bjh.12749
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Minimal residual disease (MRD) is a major predictive factor of the cure rate of acute lymphoblastic leukaemia (ALL). Haematopoietic cell transplantation is a treatment option for patients at high risk of relapse. Between 2005 and 2008, we conducted a prospective study evaluating the feasibility and efficacy of the reduction of immunosuppressive medication shortly after a non-ex vivo T depleted myeloablative transplantation. Immunoglobulin (Ig)H/T-cell receptor MRD 30d before transplant could be obtained in 122 of the 133 cases of high-risk paediatric ALL enrolled. There were no significant demographic differences except remission status (first or second complete remission) between the 95 children with MRD MRD >= 10(-3). Multivariate analysis identified sex match and MRD as being significantly associated with 5-year survival. MRD >= 10(-3) compromised the 5-year cumulative incidence of relapse (43 center dot 6 vs. 16 center dot 7%). Complete remission status and stem cell source did not modify the relationship between MRD and prognosis. Thus, pre-transplant MRD is still a major predictor of outcome for ALL. The MRD-guided strategy resulted in survival for 72 center dot 3% of patients with MRDMRD >= 10(-3).
引用
收藏
页码:392 / 401
页数:10
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