title: Impact of pretransplant minimal residual disease after cord blood transplantation for childhood acute lymphoblastic leukemia in remission: an Eurocord, PDWP-EBMT analysis.
abstract: To address the prognostic value of minimal residual disease (MRD) before unrelated cord blood transplantation (UCBT) in children with acute lymphoblastic leukemia (ALL), we analyzed 170 ALL children transplanted in complete remission (CR) after myeloablative conditioning regimen. In all, 72 (43%) were in first CR (CR1), 77 (45%) in second CR (CR2) and 21 (12%) in third CR (CR3). The median interval from MRD quantification to UCBT was 18 days. All patients received single-unit UCBT. Median follow-up was 4 years. Cumulative incidence (CI) of day-60 neutrophil engraftment was 85%. CI of 4 years relapse was 30%, incidence being lower in patients with negative MRD before UCBT (hazard ratio (HR)=0.4, P=0.01) and for those transplanted in CR1 and CR2 (HR=0.3, P=0.002). Probability of 4 years leukemia-free survival (LFS) was 44%, (56, 44 and 14% for patients transplanted in CR1, CR2 and CR3, respectively (P=0.0001)). Patients with negative MRD before UCBT had better LFS after UCBT compared with those with positive MRD (54% vs 29%; HR=2, P=0.003). MRD assessment before UCBT for children with ALL in remission allows identifying patients at higher risk of relapse after transplantation. Approaches that may decrease relapse incidence in children given UCBT with positive MRD should be investigated to improve final outcomes.
authors.affiliation: Eurocord, Hôpital Saint Louis APHP, University Paris VII IUH Paris, France. annalisa.ruggeri@eurocord.org
authors.forename: A
authors.initials: A
authors.lastname: Ruggeri
authors.forename: G
authors.initials: G
authors.lastname: Michel
authors.forename: J-H
authors.initials: JH
authors.lastname: Dalle
authors.forename: M
authors.initials: M
authors.lastname: Caniglia
authors.forename: F
authors.initials: F
authors.lastname: Locatelli
authors.forename: A
authors.initials: A
authors.lastname: Campos
authors.forename: C D
authors.initials: CD
authors.lastname: de Heredia
authors.forename: M
authors.initials: M
authors.lastname: Mohty
authors.forename: J M P
authors.initials: JM
authors.lastname: Hurtado
authors.forename: M
authors.initials: M
authors.lastname: Bierings
authors.forename: H
authors.initials: H
authors.lastname: Bittencourt
authors.forename: M
authors.initials: M
authors.lastname: Mauad
authors.forename: D
authors.initials: D
authors.lastname: Purtill
authors.forename: R
authors.initials: R
authors.lastname: Cunha
authors.forename: N
authors.initials: N
authors.lastname: Kabbara
authors.forename: E
authors.initials: E
authors.lastname: Gluckman
authors.forename: M
authors.initials: M
authors.lastname: Labopin
authors.forename: C
authors.initials: C
authors.lastname: Peters
authors.forename: V
authors.initials: V
authors.lastname: Rocha
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D036101:Cord Blood Stem Cell Transplantation / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D006801:Humans; D007223:Infant; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D018365:Neoplasm, Residual / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications / Q000401:mortality* / Q000628:therapy; D011379:Prognosis; D012042:Registries; D012074:Remission Induction; D012189:Retrospective Studies; D015996:Survival Rate; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous