Detectable minimal residual disease before hematopoietic cell transplantation is prognostic but does not preclude cure for children with very-high-risk leukemia

Wing Leung, Ching Hon Pui, Elaine Coustan-Smith, Jie Yang, Deqing Pei, Kwan Gan, Ashok Srinivasan, Christine Hartford, Brandon M. Triplett, Mari Dallas, Asha Pillai, David Shook, Jeffrey E. Rubnitz, John T. Sandlund, Sima Jeha, Hiroto Inaba, Raul C. Ribeiro, Rupert Handgretinger, Joseph H. Laver, Dario Campana

Research output: Contribution to journalArticle

120 Scopus citations

Abstract

In patients with acute leukemia, detection of minimal residual disease (MRD) before allogeneic hematopoietic cell transplantation (HCT) correlates with risk of relapse. However, the level of MRD that is most likely to preclude cure by HCT is unclear, and the benefit of further chemotherapy to reduce MRD before HCT is unknown. In 122 children with very-high-risk acute lymphoblastic leukemia (ALL; n = 64) or acute myeloid leukemia (AML, n = 58), higher MRD levels at the time of HCT predicted a poorer survival after HCT (P = .0019); MRD was an independent prognostic factor in a multivariate analysis (P = .0035). However, the increase in risk of death associated with a similar increment of MRD was greater in ALL than in AML, suggesting that a pretransplantation reduction of leukemia burden would have a higher impact in ALL. At any given MRD level, survival rates were higher for patients treated in recent protocols: the 5-year overall survival for patients with ALL was 49% if MRD was detectable and 88% if it was not and the corresponding rates for patients with AML were 67% and 80%, respectively. Although MRD before HCT is a strong prognostic factor, its impact has diminished and should not be regarded as a contraindication for HCT.

Original languageEnglish (US)
Pages (from-to)468-472
Number of pages5
JournalBlood
Volume120
Issue number2
DOIs
StatePublished - Jul 12 2012
Externally publishedYes

ASJC Scopus subject areas

  • Biochemistry
  • Immunology
  • Hematology
  • Cell Biology

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    Leung, W., Pui, C. H., Coustan-Smith, E., Yang, J., Pei, D., Gan, K., Srinivasan, A., Hartford, C., Triplett, B. M., Dallas, M., Pillai, A., Shook, D., Rubnitz, J. E., Sandlund, J. T., Jeha, S., Inaba, H., Ribeiro, R. C., Handgretinger, R., Laver, J. H., & Campana, D. (2012). Detectable minimal residual disease before hematopoietic cell transplantation is prognostic but does not preclude cure for children with very-high-risk leukemia. Blood, 120(2), 468-472. https://doi.org/10.1182/blood-2012-02-409813