Early MRD response as a prognostic factor in adult patients with acute lymphoblastic leukemia
Language English Country England, Great Britain Media print-electronic
Document type Journal Article, Research Support, Non-U.S. Gov't
PubMed
25997106
DOI
10.1111/ejh.12587
Knihovny.cz E-resources
- Keywords
- BCR-ABL, acute lymphoblastic leukemia, early response, immunoglobulin and T-cell receptor gene rearrangements, minimal residual disease, prognostic factors,
- MeSH
- Precursor Cell Lymphoblastic Leukemia-Lymphoma genetics mortality pathology therapy MeSH
- Survival Analysis MeSH
- Fusion Proteins, bcr-abl genetics MeSH
- Adult MeSH
- Gene Rearrangement MeSH
- Genes, T-Cell Receptor MeSH
- Immunoglobulins genetics MeSH
- Remission Induction MeSH
- Middle Aged MeSH
- Humans MeSH
- Adolescent MeSH
- Young Adult MeSH
- Prognosis MeSH
- Antineoplastic Combined Chemotherapy Protocols therapeutic use MeSH
- Neoplasm, Residual diagnosis genetics MeSH
- Aged MeSH
- Treatment Outcome MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Adolescent MeSH
- Young Adult MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
- Names of Substances
- Fusion Proteins, bcr-abl MeSH
- Immunoglobulins MeSH
OBJECTIVE: To evaluate the prognostic power of minimal residual disease (MRD) monitored by polymerase chain reaction at defined time points during early treatment in adult patients with acute lymphoblastic leukemia (ALL). METHODS: Seventy-one patients were treated according to the GMALL 07/2003 protocol and evaluated for MRD in bone marrow by specific clonal rearrangements of Ig/TCR in BCR-ABL negative ALL or fusion gene transcript in BCR-ABL positive ALL. RESULTS: Three-year overall survival (OS) was 94% in patients with BCR-ABL negative ALL reaching complete molecular response (CMR) after the first course of chemotherapy (vs. 32% if MRD >10(-4) ; P = 0.001). Patients with CMR prior to the start of consolidation chemotherapy at week 11 had 3-yr OS 82% (vs. 18% if MRD >10(-4) ; P = 0.001). Patients with BCR-ABL positive ALL showed slower MRD dynamics. There was a trend to better OS in patients with ≥ 4 log reduction of BCR-ABL transcript prior to HSCT (92% vs. 50%; P = 0.065). None of the patients with detectable MRD (both BCR-ABL positive and negative) after HSCT survived 3 yr. CONCLUSION: Early MRD kinetics is an important tool for new prognostication models with direct clinical impact irrespective of standard prognostic factors in patients with BCR-ABL negative ALL.
Department of Internal Medicine Hematology and Oncology University Hospital Brno Brno Czech Republic
Institute of Hematology and Blood Transfusion Prague Czech Republic
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