title: Clinical impact of minimal residual disease in children with different subtypes of acute lymphoblastic leukemia treated with Response-Adapted therapy.
abstract: To determine the clinical significance of minimal residual disease (MRD) in patients with prognostically relevant subtypes of childhood acute lymphoblastic leukemia (ALL), we analyzed data from 488 patients treated in St Jude Total Therapy Study XV with treatment intensity based mainly on MRD levels measured during remission induction. MRD levels on day 19 predicted treatment outcome for patients with hyperdiploid >50 ALL, National Cancer Institute (NCI) standard-risk B-ALL or T-cell ALL, while MRD levels on day 46 were prognostic for patients with NCI standard-risk or high-risk B-ALL. Patients with t(12;21)/(ETV6-RUNX1) or hyperdiploidy >50 ALL had the best prognosis; those with a negative MRD on day 19 had a particularly low risk of relapse: 1.9% and 3.8%, respectively. Patients with NCI high-risk B-ALL or T-cell ALL had an inferior outcome; even with undetectable MRD on day 46, cumulative risk of relapse was 12.7% and 15.5%, respectively. Among patients with NCI standard-risk B-ALL, the outcome was intermediate overall but was poor if MRD was ⩾1% on day 19 or MRD was detectable at any level on day 46. Our results indicate that the clinical impact of MRD on treatment outcome in childhood ALL varies considerably according to leukemia subtype and time of measurement.
authors: Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA.|Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, USA.|The University of Tennessee Health Science Center, Memphis, TN, USA.
authors: C-H
authors: CH
authors: Pui
authors: Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA.
authors: D
authors: D
authors: Pei
authors: Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, USA.
authors: S C
authors: SC
authors: Raimondi
authors: Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA.
authors: E
authors: E
authors: Coustan-Smith
authors: Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA.
authors: S
authors: S
authors: Jeha
authors: Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA.
authors: C
authors: C
authors: Cheng
authors: Department of Pediatrics, University of North Texas Health Science Center, Fort Worth, TX, USA.
authors: W P
authors: WP
authors: Bowman
authors: Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA.
authors: J T
authors: JT
authors: Sandlund
authors: Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA.
authors: R C
authors: RC
authors: Ribeiro
authors: Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA.
authors: J E
authors: JE
authors: Rubnitz
authors: Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA.
authors: H
authors: H
authors: Inaba
authors: Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA.
authors: T A
authors: TA
authors: Gruber
authors: Department of Bone Marrow Transplantation & Cellular Therapy, St. Jude Children's Research Hospital, Memphis, TN, USA.
authors: W H
authors: WH
authors: Leung
authors: Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, TN, USA.
authors: J J
authors: JJ
authors: Yang
authors: Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, USA.
authors: J R
authors: JR
authors: Downing
authors: Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, TN, USA.
authors: W E
authors: WE
authors: Evans
authors: Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, TN, USA.
authors: M V
authors: MV
authors: Relling
authors: Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA.
authors: D
authors: D
authors: Campana
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007223:Infant; D008297:Male; D018365:Neoplasm, Residual / Q000473:pathology* / Q000628:therapy*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000175:diagnosis* / Q000235:genetics / Q000401:mortality / Q000628:therapy*; D011379:Prognosis; D012008:Recurrence; D012074:Remission Induction; D016019:Survival Analysis; D016896:Treatment Outcome