Prognostic impact of minimal residual disease at the end of consolidation in NCI standard-risk B-lymphoblastic leukemia: A report from the Children's Oncology Group

Rachel E Rau; Yunfeng Dai; Meenakshi Devidas; Karen R Rabin; Patrick Zweidler-McKay; Anne Angiolillo; Reuven J Schore; Michael J Burke; Wanda L Salzer; Nyla A Heerema; Andrew J Carroll; Naomi J Winick; Stephen P Hunger; Elizabeth A Raetz; Mignon L Loh; Brent L Wood; Michael J Borowitz

doi:10.1002/pbc.28929

Prognostic impact of minimal residual disease at the end of consolidation in NCI standard-risk B-lymphoblastic leukemia: A report from the Children's Oncology Group

Pediatr Blood Cancer. 2021 Apr;68(4):e28929. doi: 10.1002/pbc.28929. Epub 2021 Feb 9.

Authors

Rachel E Rau¹, Yunfeng Dai², Meenakshi Devidas³, Karen R Rabin¹, Patrick Zweidler-McKay⁴, Anne Angiolillo⁵, Reuven J Schore⁵, Michael J Burke⁶, Wanda L Salzer⁷, Nyla A Heerema⁸, Andrew J Carroll⁹, Naomi J Winick¹⁰, Stephen P Hunger¹¹, Elizabeth A Raetz¹², Mignon L Loh¹³, Brent L Wood¹⁴, Michael J Borowitz¹⁵

Affiliations

¹ Division of Pediatric Hematology/Oncology, Texas Children's Cancer Center, Baylor College of Medicine, Houston, Texas, USA.
² Department of Biostatistics, Colleges of Medicine, Public Health and Health Professions, University of Florida, Gainesville, Florida, USA.
³ Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, Tennessee, USA.
⁴ Immunogen, Inc., Waltham, Massachusetts, USA.
⁵ Division of Pediatric Oncology, Children's National Medical Center, Washington, DC and the George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA.
⁶ Division of Pediatric Hematology-Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
⁷ U.S. Army Medical Research and Materiel Command, Fort Detrick, Frederick, Maryland, USA.
⁸ Department of Pathology, The Ohio State University Wexner School of Medicine, Columbus, Ohio, USA.
⁹ Department of Genetics, University of Alabama at Birmingham, Birmingham, Alabama, USA.
¹⁰ Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
¹¹ Department of Pediatrics and the Center for Childhood Cancer Research, Children's Hospital of Philadelphia and the Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
¹² Department of Pediatrics, New York University Langone Medical Center, New York, New York, USA.
¹³ Department of Pediatrics, Benioff Children's Hospital and the Helen Diller Family Comprehensive Cancer Center, University of California School of Medicine, San Francisco, California, USA.
¹⁴ Department of Pathology and Laboratory Medicine, Children's Hospital of Los Angeles, University of Southern California, Los Angeles, California, USA.
¹⁵ Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.

Abstract

The 5-year disease-free survival (DFS) of National Cancer Institute (NCI) high-risk (HR) B-lymphoblastic leukemia (B-ALL) patients with end of induction (EOI) minimal residual disease (MRD) ≥0.1% and end of consolidation (EOC) MRD ≥0.01% is 39 ± 7%, warranting consideration of hematopoietic stem cell transplant (HSCT). However, the impact of EOC MRD in NCI standard-risk (SR) B-ALL patients using COG regimens is unknown. We found that SR patients with MRD ≥0.01% at both EOI and EOC have a 4-year DFS/overall survival (OS) of 72.9 ± 19.0%/91.7 ± 10.8% versus 90.7 ± 2.9%/95.5 ± 2.0% (p = .0019/.25) for those with EOI MRD ≥0.01% and EOC MRD <0.01%. These data suggest that routine use of HSCT may not be warranted in EOC MRD ≥0.01% SR patients.

Keywords: ALL; B-lymphoblastic leukemia; minimal residual disease.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Child
Child, Preschool
Consolidation Chemotherapy
Disease-Free Survival
Female
Hematopoietic Stem Cell Transplantation
Humans
Infant
Male
Neoplasm, Residual / diagnosis*
Neoplasm, Residual / epidemiology
Neoplasm, Residual / therapy
Precursor Cell Lymphoblastic Leukemia-Lymphoma / diagnosis*
Precursor Cell Lymphoblastic Leukemia-Lymphoma / epidemiology
Precursor Cell Lymphoblastic Leukemia-Lymphoma / therapy
Prognosis
Risk Factors
United States / epidemiology

Abstract

Publication types

MeSH terms

Grants and funding