TY - JOUR
T1 - Impact of pretransplant minimal residual disease after cord blood transplantation for childhood acute lymphoblastic leukemia in remission
T2 - An Eurocord, PDWP-EBMT analysis
AU - Ruggeri, A.
AU - Michel, G.
AU - Dalle, J. H.
AU - Caniglia, M.
AU - Locatelli, F.
AU - Campos, A.
AU - De Heredia, C. D.
AU - Mohty, M.
AU - Hurtado, J. M P
AU - Bierings, M.
AU - Bittencourt, H.
AU - Mauad, M.
AU - Purtill, D.
AU - Cunha, R.
AU - Kabbara, N.
AU - Gluckman, E.
AU - Labopin, M.
AU - Peters, C.
AU - Rocha, V.
PY - 2012/12
Y1 - 2012/12
N2 - 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.
AB - 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.
KW - acute lymphoblastic leukemia
KW - children
KW - cord blood transplantation
KW - minimal residual disease
KW - relapse
UR - http://www.scopus.com/inward/record.url?scp=84871198014&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84871198014&partnerID=8YFLogxK
U2 - 10.1038/leu.2012.123
DO - 10.1038/leu.2012.123
M3 - Article
C2 - 22555150
AN - SCOPUS:84871198014
VL - 26
SP - 2455
EP - 2461
JO - Leukemia
JF - Leukemia
SN - 0887-6924
IS - 12
ER -