title: Satisfactory outcome after intensive chemotherapy with pragmatic use of minimal residual disease (MRD) monitoring in older patients with Philadelphia-negative B cell precursor acute lymphoblastic leukaemia: a Swedish registry-based study.
abstract: The introduction of minimal residual disease (MRD) monitoring, in the Swedish national guidelines for acute lymphoblastic leukaemia, was evaluated in 35 patients aged 46-79 years (median 61), who were diagnosed from 2007 to 2011 and treated with high-intensity, block-based chemotherapy (ABCDV/VABA induction). Both a high complete remission rate (91 %) and acceptable overall survival (OS) rate (47 %) at 5 years were achieved. MRD by flow cytometry was measured in 73 % of the patients reaching complete remission after the first course, but was omitted by the clinicians for eight patients who were either over 70 years of age or already met conventional high-risk criteria. Factors negatively influencing OS were age over 65 years and WHO status ≥2. MRD < 0.1 % after induction had positive impact on continuous complete remission but not on OS. Only five patients were allocated to allogeneic haematopoietic stem cell transplantation in first remission, mainly due to conventional high risk factors. Thus, use of intensive remission induction therapy is effective in a selection of older patients. In a population for whom the possibilities of treatment escalation are limited, the optimal role of MRD monitoring remains to be determined.
authors: Department of Medical Sciences, Haematology, Uppsala University, Uppsala, Sweden, emma.bergfelt@medsci.uu.se.
authors: Emma
authors: E
authors: Bergfelt
authors: Piotr
authors: P
authors: Kozlowski
authors: Lucia
authors: L
authors: Ahlberg
authors: Erik
authors: E
authors: Hulegårdh
authors: Hans
authors: H
authors: Hägglund
authors: Karin
authors: K
authors: Karlsson
authors: Alicja
authors: A
authors: Markuszewska-Kuczymska
authors: Beata
authors: B
authors: Tomaszewska-Toporska
authors: Bengt
authors: B
authors: Smedmyr
authors: Maria
authors: M
authors: Åström
authors: Rose-Marie
authors: RM
authors: Amini
authors: Heléne
authors: H
authors: Hallböök
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D005260:Female; D005434:Flow Cytometry / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D018365:Neoplasm, Residual / Q000175:diagnosis* / Q000401:mortality* / Q000473:pathology; D010677:Philadelphia Chromosome; D015452:Precursor B-Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D012074:Remission Induction; D015996:Survival Rate