Abstract
Risk stratification and treatment intensification, based on minimal residual disease (MRD) mensurement, changed the prognosis of pediatric patients with acute lymphocytic leukemia (ALL). The main aim of this study was to investigate whether peripheral blood (PB) MRD measurement at day 8 (D8) could predict the risk stratification category determined by bone marrow (BM) MRD at day 15 (D15). The study was performed prospectively, in a cohort of 40 children with B-lineage ALL, adopting the protocol of the Brazilian Cooperative Group of the Treatment Childhood Leukemia (GBTLI-2009). MRD was detected by flow cytometry (FC) using a simplifed panel that can reliably identify MRD at early phases of induction therapy. Upon diagnosis, the proportion of low and high-risk patients, was 24:16 (60%:40%). The main result of our study demonstrated the potential of D8 MRD in anticipating of week the risk stratification of high-risk patients as determined by D15 BM MRD. In these patients D8 MRD level of 1% was able to segregate high risk fast responders from high risk slow responders (p = 0.0097). This result could represent an opportunity for early treatment intensification, as already performed in some protocols.
Highlights
Risk stratification and treatment intensification, based on minimal residual disease (MRD) mensurement, changed the prognosis of pediatric patients with acute lymphocytic leukemia (ALL)
Risk stratification and selected treatment intensification based on Minimal Residual Disease” (MRD) detection have changed the prognosis of ALL patients[11]
The feasibility and potential benefits of using MRD measurement as early as day 8 (D8) have been demonstrated by the Children’s Oncology Group (COG) group in 2008
Summary
Risk stratification and treatment intensification, based on minimal residual disease (MRD) mensurement, changed the prognosis of pediatric patients with acute lymphocytic leukemia (ALL). The main result of our study demonstrated the potential of D8 MRD in anticipating of week the risk stratification of high-risk patients as determined by D15 BM MRD. In these patients D8 MRD level of 1% was able to segregate high risk fast responders from high risk slow responders (p = 0.0097) This result could represent an opportunity for early treatment intensification, as already performed in some protocols. Current ALL protocols associate morphological analysis with MRD measurement to evaluate treatment response on both early and late time-points, providing more timely and accurate prognostic information of treatment outcome[2,4,10]. We present the results of an independent study to evaluate the impact of D8 MRD measurement on risk stratification in a prospective cohort of 40 patients with ALL
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