BACKGROUND: The outcome of infants with KMT2A-germline acute lymphoblastic leukaemia (ALL) is superior to that of infants with KMT2A-rearranged ALL but has been inferior to non-infant ALL patients. Here, we describe the outcome and prognostic factors for 167 infants with KMT2A-germline ALL enrolled in the Interfant-06 study. METHODS: Univariate analysis on prognostic factors (age, white blood cell count at diagnosis, prednisolone response and CD10 expression) was performed on KMT2A-germline infants in complete remission at the end of induction (EOI; n = 163). Bone marrow minimal residual disease (MRD) was measured in 73 patients by real-time quantitative polymerase chain reaction at various time points (EOI, n = 68; end of consolidation, n = 56; and before OCTADAD, n = 57). MRD results were classified as negative, intermediate (<5∗10-4), and high (≥5∗10-4). RESULTS: The 6-year event-free and overall survival was 73.9% (standard error [SE] = 3.6) and 87.2% (SE = 2.7). Relapses occurred early, within 36 months from diagnosis in 28 of 31 (90%) infants. Treatment-related mortality was 3.6%. Age <6 months was a favourable prognostic factor with a 6-year disease-free survival (DFS) of 91% (SE = 9.0) compared with 71.7% (SE = 4.2) in infants >6 months of age (P = 0.04). Patients with high EOI MRD ≥5 × 10-4 had a worse outcome (6-year DFS 61.4% [SE = 12.4], n = 16), compared with patients with undetectable EOI MRD (6-year DFS 87.9% [SE = 6.6], n = 28) or intermediate EOI MRD <5 × 10-4 (6-year DFS 76.4% [SE = 11.3], n = 24; P = 0.02). CONCLUSION: We conclude that young age at diagnosis and low EOI MRD seem favourable prognostic factors in infants with KMT2A-germline ALL and should be considered for risk stratification in future clinical trials.

Australian and New Zealand Children's Haematology Oncology Group Perth Children's Hospital Perth Australia; Telethon Kids Cancer Centre Telethon Kids Institute University of Western Australia Perth Australia

Berlin Frankfurt Miu nster Group Germany Kiel Germany

Center of Bioinformatics Biostatistics and Bioimaging University of Milano Bicocca Monza Italy

Center of Bioinformatics Biostatistics and Bioimaging University of Milano Bicocca Monza Italy; Pediatrics School of Medicine and Surgery University of Milano Bicocca Fondazione MBBM San Gerardo Hospital Monza Italy

Chilean National Pediatric Oncology Group Santiago Chile

CLIP Department of Paediatric Haematology and Oncology 2nd Faculty of Medicine Charles University and University Hospital Motol Prague Czech Republic

Czech Working Group for Pediatric Hematology Prague Czech Republic

Dana Farber Cancer Institute Pediatric Oncology Boston MA USA

Department of Immunology Erasmus University Medical Center the Netherlands

Department of Pediatric Haematology and Oncology IRCCS Ospedale Pediatrico Bambino Gesù Sapienza University of Rome Rome Italy

Department of Pediatric Hematology University Robert Debre Hospital APHP Paris France

European Organisation for Research and Treatment of Cancer Children Leukemia Group Brussels Belgium

GATLA Buenos Aires Argentina

German Cooperative Study Group for Childhood Acute Lymphoblastic Leukemia Hamburg Germany

Pediatric Oncology Princess Máxima Center for Pediatric Oncology Utrecht the Netherlands

Pediatric Oncology Princess Máxima Center for Pediatric Oncology Utrecht the Netherlands; Dutch Childhood Oncology Group Utrecht the Netherlands

Pediatric Oncology Princess Máxima Center for Pediatric Oncology Utrecht the Netherlands; Oncode Institute Utrecht the Netherlands

Pediatrics School of Medicine and Surgery University of Milano Bicocca Fondazione MBBM San Gerardo Hospital Monza Italy

Pediatrics University Medical Center Schleswig Holstein Christian Albrechts University of Kiel Germany

Polish Pediatric Leukemia Lymphoma Study Group Department of Pediatric Hematology and Oncology Medical University of Silesia Zabrze Katowice Poland

Rigshospitalet University Hospital Department of Pediatrics Copenhagen Denmark

St Anna Children's Hospital Pediatric Hematology and Oncology Austria

Tettamanti Research Center Pediatrics School of Medicine and Surgery University of Milano Bicocca Monza Italy

The Chinese University of Hong Kong Shatin Hong Kong Special Administrative Region People's Republic of China

United Kingdom Children Cancer Study Group London United Kingdom

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