Prognostic and therapeutic implications of measurable residual disease levels during remission induction of childhood ALL

We evaluated the prognostic and therapeutic significance of measurable residual disease (MRD) during remission induction in pediatric patients with acute lymphoblastic leukemia (ALL). In the Chinese Children Cancer Group ALL 2015 protocol, 7640 patients were categorized into low-, intermediate-, or high-risk groups based on clinical and genetic features. Final risk classification was determined by assessing MRD using flow cytometry on days 19 and 46 of remission induction with additional intensified chemotherapy for day 19 MRD ≥1%. Patients with B-ALL with negative MRD (<0.01%) on day 19 or day 46 had significantly better 5-year event-free survival (EFS) than those with MRD of between 0.01% and 0.99% who, in turn, had better EFS than patients with MRD of ≥1%. Provisional low-risk patients with day 19 MRD ≥1% but negative day 46 MRD who were reclassified as intermediate risk had a 5-year EFS that was comparable with that of low-risk patients with day 19 MRD of 0.3% to 0.99% and negative day 46 MRD (82.5% vs 83.0%) and better EFS than provisional low-risk patients with MRD on both days (83.0% vs 72.6%; P < .001). Similarly, patients with provisional intermediate-risk B-ALL with day 19 MRD ≥1% but negative day 46 MRD who received additional therapy had better 5-year EFS than those with day 19 MRD between 0.3% and 0.99% (70.7% vs 53.0%; P < .001). Among low-risk patients with negative day 46 MRD, those with negative day 19 MRD had superior EFS than those with positive day 19 MRD (91.7% vs 86.1%; P < .001). Optimal use of day 19 MRD could improve individualized treatment and outcomes. This trial was registered at www.chictr.org.cn as #ChiCTR-IPR-14005706.

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Publication Details

Journal
Blood
Published
2024-12-30
DOI
https://doi.org/10.1182/blood.2024026381
Citations
2
Primary Topic
Acute Lymphoblastic Leukemia research
Type
article
Field-Weighted Citation Impact
1.09
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article

Prognostic and therapeutic implications of measurable residual disease levels during remission induction of childhood ALL

Lingzhen Wang, Ching‐Hon Pui, Frankie Wai Tsoi Cheng, Xiaofan Zhu et al.
2 citations
Blood
Acute Lymphoblastic Leukemia research
1.09
article

Prognostic and therapeutic implications of measurable residual disease levels during remission induction of childhood ALL

Lingzhen Wang, Ching‐Hon Pui, Frankie Wai Tsoi Cheng, Xiaofan Zhu, Xiaowen Zhai, Jia‐Shi Zhu, Ningling Wang, Yani Ma, Jun J. Yang, Ju Gao, Jie Yu, Jiaoyang Cai, Benshang Li, Yongjun Fang, Xin Tian, Cheng Cheng, Xue Li, Xiang Wang, Weina Zhang, Chi Kong Li, Ge Zhang, Xiaoxiao Xu, Aiguo Liu, Fen Zhou, Hua Jiang, Shuhong Shen, Changda Liang, Peifang Xiao, Liangchun Yang
article en
2 citations

Abstract

We evaluated the prognostic and therapeutic significance of measurable residual disease (MRD) during remission induction in pediatric patients with acute lymphoblastic leukemia (ALL). In the Chinese Children Cancer Group ALL 2015 protocol, 7640 patients were categorized into low-, intermediate-, or high-risk groups based on clinical and genetic features. Final risk classification was determined by assessing MRD using flow cytometry on days 19 and 46 of remission induction with additional intensified chemotherapy for day 19 MRD ≥1%. Patients with B-ALL with negative MRD (<0.01%) on day 19 or day 46 had significantly better 5-year event-free survival (EFS) than those with MRD of between 0.01% and 0.99% who, in turn, had better EFS than patients with MRD of ≥1%. Provisional low-risk patients with day 19 MRD ≥1% but negative day 46 MRD who were reclassified as intermediate risk had a 5-year EFS that was comparable with that of low-risk patients with day 19 MRD of 0.3% to 0.99% and negative day 46 MRD (82.5% vs 83.0%) and better EFS than provisional low-risk patients with MRD on both days (83.0% vs 72.6%; P < .001). Similarly, patients with provisional intermediate-risk B-ALL with day 19 MRD ≥1% but negative day 46 MRD who received additional therapy had better 5-year EFS than those with day 19 MRD between 0.3% and 0.99% (70.7% vs 53.0%; P < .001). Among low-risk patients with negative day 46 MRD, those with negative day 19 MRD had superior EFS than those with positive day 19 MRD (91.7% vs 86.1%; P < .001). Optimal use of day 19 MRD could improve individualized treatment and outcomes. This trial was registered at www.chictr.org.cn as #ChiCTR-IPR-14005706.

BloodVol. 145(17)
Qingdao University (CN), St. Jude Children's Research Hospital (US), Central South University (CN), Chinese University of Hong Kong (HK), Shanghai Jiao Tong University (CN), Soochow University (TW), Anhui Medical University (CN), Chinese Academy of Medical Sciences & Peking Union Medical College (CN), Sichuan University (CN), Soochow University (CN), Nanjing Children's Hospital (CN), Kunming Children's Hospital (CN), Shanghai Children's Medical Center (CN), Duchess of Kent Children's Hospital (CN), Northwest Women's and Children's Hospital (CN), Nanfang Hospital (CN), Guangzhou Women and Children Medical Center (CN), Affiliated Hospital of Qingdao University (CN), Wuhan Union Hospital (CN), Second Affiliated Hospital of Nanjing Medical University (CN), Jiangxi Provincial Children's Hospital (CN), Institute of Hematology & Blood Diseases Hospital (CN), Second Affiliated Hospital of Anhui Medical University (CN), Children's Hospital of Fudan University (CN), Shanghai Children's Hospital (CN), Children's Hospital of Chongqing Medical University (CN), Xiangya Hospital Central South University (CN), Tongji Hospital (CN), Qilu Hospital of Shandong University (CN), Union Hospital (CN), Huazhong University of Science and Technology (CN), Southern Medical University (CN), Chongqing Medical University (CN), Guangzhou Medical University (CN)
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Openalex Percentile: Top 19%
Acute Lymphoblastic Leukemia research
1.09
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