Impact of pretransplant minimal residual disease after cord blood transplantation for childhood acute lymphoblastic leukemia in remission: An Eurocord, PDWP-EBMT analysis

A. Ruggeri, G. Michel, J. H. Dalle, M. Caniglia, F. Locatelli, A. Campos, C. D. De Heredia, M. Mohty, J. M P Hurtado, M. Bierings, H. Bittencourt, M. Mauad, D. Purtill, R. Cunha, N. Kabbara, E. Gluckman, M. Labopin, C. Peters, V. Rocha

Research output: Contribution to journalArticlepeer-review

Abstract

To address the prognostic value of minimal residual disease (MRD) before unrelated cord blood transplantation (UCBT) in children with acute lymphoblastic leukemia (ALL), we analyzed 170 ALL children transplanted in complete remission (CR) after myeloablative conditioning regimen. In all, 72 (43%) were in first CR (CR1), 77 (45%) in second CR (CR2) and 21 (12%) in third CR (CR3). The median interval from MRD quantification to UCBT was 18 days. All patients received single-unit UCBT. Median follow-up was 4 years. Cumulative incidence (CI) of day-60 neutrophil engraftment was 85%. CI of 4 years relapse was 30%, incidence being lower in patients with negative MRD before UCBT (hazard ratio (HR)=0.4, P=0.01) and for those transplanted in CR1 and CR2 (HR=0.3, P=0.002). Probability of 4 years leukemia-free survival (LFS) was 44%, (56, 44 and 14% for patients transplanted in CR1, CR2 and CR3, respectively (P=0.0001)). Patients with negative MRD before UCBT had better LFS after UCBT compared with those with positive MRD (54% vs 29%; HR=2, P=0.003). MRD assessment before UCBT for children with ALL in remission allows identifying patients at higher risk of relapse after transplantation. Approaches that may decrease relapse incidence in children given UCBT with positive MRD should be investigated to improve final outcomes.

Original languageEnglish
Pages (from-to)2455-2461
Number of pages7
JournalLeukemia
Volume26
Issue number12
DOIs
Publication statusPublished - Dec 2012

Keywords

  • acute lymphoblastic leukemia
  • children
  • cord blood transplantation
  • minimal residual disease
  • relapse

ASJC Scopus subject areas

  • Hematology
  • Cancer Research
  • Anesthesiology and Pain Medicine

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