Minimal residual disease level predicts outcome in adults with Ph-negative Bprecursor acute lymphoblastic leukemia
Gökbuget, Nicola (University Hospital of Frankfurt (Alemanya))
Dombret, Hervé (Hôpital Saint-Louis, Université Paris Diderot)
Giebel, Sebastian (Maria Sklodowska Curie Memorial Cancer Center, Gliwice)
Bruggemann, Monika (Universitätsklinikum Schleswig-Holstein)
Doubek, Michael (University Hospital Brno (República Txeca))
Foà, Robin (Università degli Studi di Roma "La Sapienza")
Hoelzer, Dieter (University Hospital of Frankfurt (Alemanya))
Kim, Christopher (Amgen Inc, Thousand Oaks, CA, USA)
Martinelli, Giovanni (IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori "Dino Amadori")
Parovichnikova, Elena (National Research Center for Hematology, Moscow)
Rambaldi, Alessandro (Dipartimento di Oncologia ed Ematologia, Università degli Studi di Milano and Ospedale Papa Giovanni XXIII)
Ribera, Jose-Maria (Institut Germans Trias i Pujol. Institut de Recerca contra la Leucèmia Josep Carreras)
Schoonen, Marieke (Amgen Ltd, London)
Stieglmaier, Julia M. (Amgen GmBH, Munich)
Zugmaier, Gerhard (Amgen GmBH, Munich)
Bassan, Renato (Ospedale dell'Angelo, Mestre-Venezia)
Universitat Autònoma de Barcelona

Data:	2019
Resum:	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.
Nota:	Institut Germans Tries i Pujol
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Acute lymphoblastic leukemia ; Minimal residual disease ; MRD ; Allogeneic stem cell transplant
Publicat a:	Hematology, Vol. 24 Núm. 1 (2019) , p. 337-348, ISSN 1607-8454

DOI: 10.1080/16078454.2019.1567654

13 p, 2.7 MB

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Documents de recerca > Documents dels grups de recerca de la UAB > Centres i grups de recerca (producció científica) > Ciències de la salut i biociències > Institut d'Investigació en Ciencies de la Salut Germans Trias i Pujol (IGTP) > Institut de Recerca contra la Leucèmia Josep Carreras
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