Clinical value of pre-transplant minimal residual disease in childhood lymphoblastic leukaemia: the results of the French minimal residual disease-guided protocol.
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 30 d 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 <10(-3) and the 27 with 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 (43·6 vs. 16·7%). 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 72·3% of patients with MRD<10(-3) and 40·4% of those with MRD ≥10(-3).
Department of Paediatric Haematology/Oncology, University Hospital of Rennes, Rennes, France.
Virginie
V
Gandemer
Cécile
C
Pochon
Emmanuel
E
Oger
Jean-Hugues H
JH
Dalle
Gérard
G
Michel
Claudine
C
Schmitt
Eva
E
de Berranger
Claire
C
Galambrun
Hélène
H
Cavé
Jean-Michel
JM
Cayuela
Nathalie
N
Grardel
Elizabeth
E
Macintyre
Geneviève
G
Margueritte
Françoise
F
Méchinaud
Pierre
P
Rorhlich
Patrick
P
Lutz
François
F
Demeocq
Pascale
P
Schneider
Dominique
D
Plantaz
Marilyne
M
Poirée
Pierre
P
Bordigoni
D000276:Adjuvants, Immunologic / Q000008:administration & dosage; D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D008297:Male; D018365:Neoplasm, Residual / Q000276:immunology / Q000473:pathology* / Q000628:therapy; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000276:immunology / Q000473:pathology* / Q000628:therapy*; D011379:Prognosis; D011446:Prospective Studies; D012074:Remission Induction; D016896:Treatment Outcome
D000276:Adjuvants, Immunologic
childhood leukaemia; mrd; prognostic factors; transplantation