Minimal Residual Disease at First Achievement of Complete Remission Predicts Outcome in Adult Patients with Philadelphia Chromosome-Negative Acute Lymphoblastic Leukemia.
We evaluated the prognostic effect of minimal residual disease at first achievement of complete remission (MRD at CR1) in adult patients with Philadelphia chromosome-negative acute lymphoblastic leukemia (ALL). A total of 97 patients received treatment in our center between 2007 and 2012 were retrospectively reviewed in this study. Patients were divided into two arms according to the post-remission therapy (chemotherapy alone or allogeneic hematopoietic stem cell transplantation (allo-HSCT)) they received. MRD was detected by four-color flow cytometry. We chose 0.02% and 0.2% as the cut-off points of MRD at CR1 for risk stratification using receiver operating characteristic analysis. The 3-year overall survival (OS) and leukemia free survival (LFS) rates for the whole cohort were 46.2% and 40.5%. MRD at CR1 had a significantly negative correlation with survival in both arms. Three-year OS rates in the chemotherapy arm were 70.0%, 25.2%, 0% (P = 0.003) for low, intermediate, and high levels of MRD at CR1, respectively. Three-year OS rates in the transplant arm were 81.8%, 64.3%, 27.3% (P = 0.005) for low, intermediate, and high levels of MRD at CR1, respectively. Multivariate analysis confirmed that higher level of MRD at CR1 was a significant adverse factor for OS and LFS. Compared with chemotherapy alone, allo-HSCT significantly improved LFS rates in patients with intermediate (P = 0.005) and high (P = 0.022) levels of MRD at CR1, but not patients with low level of MRD at CR1 (P = 0.851). These results suggested that MRD at CR1 could strongly predict the outcome of adult ALL. Patients with intermediate and high levels of MRD at CR1 would benefit from allo-HSCT.
Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China.
Mingming
M
Zhang
Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China.
Huarui
H
Fu
Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China.
Xiaoyu
X
Lai
Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China.
Yamin
Y
Tan
Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China.
Weiyan
W
Zheng
Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China.
Jimin
J
Shi
Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China.
Yanmin
Y
Zhao
Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China.
Maofang
M
Lin
Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China.
Jingsong
J
He
Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China.
Zhen
Z
Cai
Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China.
Yi
Y
Luo
Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China.
He
H
Huang
D000328:Adult; D018572:Disease-Free Survival; D005260:Female; D005434:Flow Cytometry; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D018365:Neoplasm, Residual / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D010677:Philadelphia Chromosome; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D011379:Prognosis; D012074:Remission Induction; D012189:Retrospective Studies; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult
Blood Cancer J. 2014 Jul 11;4:e225
25014772
Blood. 2014 Jun 12;123(24):3739-49
24740809
J Clin Oncol. 2014 May 20;32(15):1595-604
24752047
Bone Marrow Transplant. 2007 Aug;40(4):381-7
17563735
Stat Med. 1999 Mar 30;18(6):695-706
10204198
Blood. 2012 Aug 30;120(9):1868-76
22442346
Blood. 2015 Apr 16;125(16):2486-96; quiz 2586
25587040
Blood. 2006 Feb 1;107(3):1116-23
16195338
Blood. 2014 Oct 23;124(17):2735-43
25214441
Br J Haematol. 2010 Jan;148(1):80-9
19863538
Br J Haematol. 2008 Jun;142(2):227-37
18492099
Blood. 2007 Feb 1;109(3):944-50
17032921
Blood. 2009 Apr 30;113(18):4153-62
19141862
Blood. 2015 Jun 25;125(26):3996-4009
25999452
J Clin Oncol. 2011 Feb 10;29(5):532-43
21220592
Semin Hematol. 2009 Jan;46(1):64-75
19100369