OBJECTIVES: Detectable minimal residual disease (MRD) after therapy for acute lymphoblastic leukemia (ALL) is the strongest predictor of hematologic relapse. This study evaluated outcomes of patients with B-cell precursor ALL with MRD of ≥10-4 Methods: Study population was from ALL study groups in Europe managed in national study protocols 2000-2014. MRD was measured by polymerase chain reaction or flow cytometry. Patients were age ≥15 years at initial ALL diagnosis. Patients were excluded if exposed to blinatumomab within 18 months of baseline or prior alloHSCT. RESULTS: Of 272 patients in CR1, baseline MRD was ≥10-1, 10-2 to <10-1, 10-3 to <10-2, and 10-4 to <10-3 in 15 (6%), 71 (26%), 109 (40%), and 77 (28%) patients, respectively. Median duration of complete remission (DoR) was 18.5 months (95% confidence interval [CI], 11.9-27.2), median relapse-free survival (RFS) was 12.4 months (95% CI, 10.0-19.0) and median overall survival (OS) was 32.5 months (95% CI, 23.6-48.0). Lower baseline MRD level (P ≤ .0003) and white blood cell count <30,000/µL at diagnosis (P ≤ .0053) were strong predictors for better RFS and DoR. Allogeneic hematopoietic stem cell transplantation (alloHSCT) was associated with longer RFS (hazard ratio [HR], 0.59; 95% CI, 0.41-0.84) and DoR (HR, 0.43; 95% CI, 0.29-0.64); the association with OS was not significant (HR, 0.72; 95% CI, 0.50-1.05). DISCUSSION: In conclusion, RFS, DoR, and OS are relatively short in patients with MRD-positive ALL, particularly at higher MRD levels. AlloHSCT may improve survival but has limitations. Alternative approaches are needed to improve outcomes in MRD-positive ALL.

b Hôpital Saint Louis University Paris Diderot Paris France

c Maria Sklodowska Curie Memorial Cancer Center Gliwice Poland

Department of Hematology and Oncology University Hospital Schleswig Holstein Campus Kiel Kiel Germany

Department of Medicine 2 Department of Hematology Oncology University Hospital Frankfurt Germany

e Department of Internal Medicine Hematology and Oncology University Hospital Brno Czech Republic

f Sapienza University of Rome Rome Italy

g Amgen Inc Thousand Oaks CA USA

h Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori IRCCS Meldola Italy

i National Research Center for Hematology Moscow Russia

j Dipartimento di Oncologia ed Ematologia Università degli Studi di Milano and Ospedale Papa Giovanni XXIII Bergamo Italy

k ICO Hospital Germans Trias 1 Pujol Josep Carreras Research Institute Barcelona Spain

l Amgen Ltd London UK

m Amgen GmBH Munich Germany

Ospedale dell'Angelo Mestre Venezia Italy

Citace poskytuje Crossref.org

The EHA Research Roadmap: Malignant Lymphoid Diseases

Blinatumomab vs historic standard-of-care treatment for minimal residual disease in adults with B-cell precursor acute lymphoblastic leukaemia