Status of minimal residual disease after induction predicts outcome in both standard and high-risk Ph-negative adult acute lymphoblastic leukaemia. The Polish Adult Leukemia Group ALL 4-2002 MRD Study

Authors: Holowiecki, Jerzy¹; Krawczyk-Kulis, Malgorzata¹; Giebel, Sebastian¹; Jagoda, Krystyna¹; Stella-Holowiecka, Beata¹; Piatkowska-Jakubas, Beata²; Paluszewska, Monika³; Seferynska, Ilona⁴; Lewandowski, Krzysztof⁵; Kielbinski, Marek⁶; Czyz, Anna⁷; Balana-Nowak, Agnieszka²; Król, Maria³; Skotnicki, Aleksander B.²; Jedrzejczak, Wieslaw W.³; Warzocha, Krzysztof⁴; Lange, Andrzej⁸; Hellmann, Andrzej⁵

Source: British Journal of Haematology, Volume 142, Number 2, July 2008 , pp. 227-237(11)

Publisher: Blackwell Publishing

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Abstract:

Summary

The treatment of adults with Philadelphia-negative acute lymphoblastic leukaemia (ALL) depends on the presence of risk factors including age, white blood cell count, immunophenotype and time to complete remission. In recent years, status of minimal residual disease (MRD) has been postulated as an additional risk criterion. This study prospectively evaluated the significance of MRD. Patients were treated with a uniform Polish Adult Leukemia Group (PALG) 4-2002 protocol. MRD status was assessed after induction and consolidation by multiparametric flow cytometry. Out of 132 patients included (age, 17-60 years), 116 patients were suitable for analysis. MRD level ≥0·1% of bone marrow cells after induction was found to be a strong and independent predictor for relapse in the whole study population (P < 0·0001), as well as in the standard risk (SR, P = 0·0003) and high-risk (P = 0·008) groups. The impact of MRD after consolidation on outcome was not significant. The combination of MRD status with conventional risk stratification system identified a subgroup of patients allocated to the SR group with MRD <0·1% after induction who had a very low risk of relapse of 9% at 3 years as opposed to 71% in the remaining subjects (P = 0·001). We conclude that MRD evaluation after induction should be considered with conventional risk criteria for treatment decisions in adult ALL.

Keywords: acute lymphoblastic leukaemia; minimal residual disease; flow cytometry

Document Type: Research article

DOI: 10.1111/j.1365-2141.2008.07185.x

Affiliations: 1: Department of Haematology and Bone Marrow Transplantation, Silesian Medical University, Katowice 2: Department of Haematology, Collegium Medicum, Jagiellonian University, Cracow 3: Department of Haematology, Oncology and Internal Diseases, Warsaw Medical Academy, Warsaw 4: Department of Haematology, Institute of Haematology and Transfusion Medicine, Warsaw 5: Department of Haematology, Institute of Internal Diseases, Gdansk Medical Academy, Gdansk 6: Department of Haematology, Haematopoietic Malignancies and Bone Marrow Transplantation, Wroclaw Medical Academy, Wroclaw 7: Department of Haematology and Haematopoietic Malignancies, Poznan Medical Academy, Poznan 8: Lower Silesian Centre for Cellular Transplantation, Wroclaw, Poland

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