Status of minimal residual disease after induction predicts outcome in both standard and high-risk Ph-negative adult acute lymphoblastic leukaemia. The Polish Adult Leukemia Group ALL 4-2002 MRD Study.
The treatment of adults with Philadelphia-negative acute lymphoblastic leukaemia (ALL) depends on the presence of risk factors including age, white blood cell count, immunophenotype and time to complete remission. In recent years, status of minimal residual disease (MRD) has been postulated as an additional risk criterion. This study prospectively evaluated the significance of MRD. Patients were treated with a uniform Polish Adult Leukemia Group (PALG) 4-2002 protocol. MRD status was assessed after induction and consolidation by multiparametric flow cytometry. Out of 132 patients included (age, 17-60 years), 116 patients were suitable for analysis. MRD level >/=0.1% of bone marrow cells after induction was found to be a strong and independent predictor for relapse in the whole study population (P < 0.0001), as well as in the standard risk (SR, P = 0.0003) and high-risk (P = 0.008) groups. The impact of MRD after consolidation on outcome was not significant. The combination of MRD status with conventional risk stratification system identified a subgroup of patients allocated to the SR group with MRD <0.1% after induction who had a very low risk of relapse of 9% at 3 years as opposed to 71% in the remaining subjects (P = 0.001). We conclude that MRD evaluation after induction should be considered with conventional risk criteria for treatment decisions in adult ALL.
Holowiecki
Jerzy
J
Department of Haematology and Bone Marrow Transplantation, Silesian Medical University, Katowice, Poland. holow@sum.edu.pl
Krawczyk-Kulis
Malgorzata
M
Giebel
Sebastian
S
Jagoda
Krystyna
K
Stella-Holowiecka
Beata
B
Piatkowska-Jakubas
Beata
B
Paluszewska
Monika
M
Seferynska
Ilona
I
Lewandowski
Krzysztof
K
Kielbinski
Marek
M
Czyz
Anna
A
Balana-Nowak
Agnieszka
A
Król
Maria
M
Skotnicki
Aleksander B
AB
Jedrzejczak
Wieslaw W
WW
Warzocha
Krzysztof
K
Lange
Andrzej
A
Hellmann
Andrzej
A
D000293:Adolescent; D000328:Adult; D015703:Antigens, CD / Q000032:analysis*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001854:Bone Marrow Cells / Q000276:immunology; D005260:Female; D005434:Flow Cytometry / Q000379:methods; D006801:Humans; D016130:Immunophenotyping / Q000379:methods; D008297:Male; D008875:Middle Aged; D018365:Neoplasm, Residual / Q000175:diagnosis* / Q000276:immunology; D011044:Poland; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000175:diagnosis* / Q000188:drug therapy; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence; D012306:Risk; D055815:Young Adult
D015703:Antigens, CD