Measurable residual disease results after consolidation therapy predictive of relapse in pediatric leukemia

For children with acute lymphoblastic leukemia (ALL), measurable residual disease (MRD) after the end of first consolidation (EOC) can be used to predict the need for subsequent MRD measurements, according to a study published online Sept. 10 in Leukemia.

Janine Stutterheim, M.D., Ph.D., from the Princess Máxima Center for Pediatric Oncology in Utrecht, Netherlands, and colleagues examined the clinical relevance of MRD after EOC in intermediate-risk patients treated in DCOG-ALL-10 and DCOG-ALL-9 (271 and 122 patients, respectively) with MRD <0.5 percent at EOC.

The researchers found that the outcomes were excellent for the 178 EOC MRD-negative patients, regardless of MRD results at later time points; the six-year cumulative incidence of relapse was 7.4 and 3.8 percent for those with MRD negativity at all later time points and for those with positivity at one or more later time points, respectively. Comparable outcomes were seen for patients with positive EOC MRD (91 patients), for whom subsequent time points were MRD-negative, with a six-year cumulative incidence of relapse of 7.0 percent. In contrast, the 48 patients who were MRD-positive at EOC and at one or more subsequent time points had a higher risk for relapse, with a six-year cumulative incidence of relapse of 29.4 percent. In the validation cohort of ALL-9, these findings were confirmed.

“In patients with MRD-based intermediate risk ALL who are MRD-negative at EOC, MRD measurement at later time points can be abandoned,” the authors write. “For patients who are EOC MRD-positive the subsequent MRD measurements might be informative for further risk stratification and therapeutic intervention.”

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