%0 Journal Article
%T Minimal residual disease level predicts outcome in adults with Ph-negative B-precursor acute lymphoblastic leukemia
%A Aless
%A Christopher Kim
%A Dieter Hoelzer
%A Elena Parovichnikova
%A Gerhard Zugmaier
%A Giovanni Martinelli
%A Herv谷 Dombret
%A Josep-Maria Ribera
%A Julia M. Stieglmaier
%A Marieke Schoonen
%A Michael Doubek
%A Monika Bruggemann
%A Nicola Gˋkbuget
%A Renato Bassan
%A Robin Fo角
%A Sebastian Giebel
%A ro Rambaldi
%J Hematology
%D 2019
%R https://doi.org/10.1080/16078454.2019.1567654
%X ABSTRACT Objectives: Detectable minimal residual disease (MRD) after therapy for acute lymphoblastic leukemia (ALL) is the strongest predictor of hematologic relapse. This study evaluated outcomes of patients with B-cell precursor ALL with MRD of ≡10ˋ4 Methods: Study population was from ALL study groups in Europe managed in national study protocols 2000每2014. MRD was measured by polymerase chain reaction or flow cytometry. Patients were age ≡15 years at initial ALL diagnosis. Patients were excluded if exposed to blinatumomab within 18 months of baseline or prior alloHSCT. Results: Of 272 patients in CR1, baseline MRD was ≡10ˋ1, 10ˋ2 to <10ˋ1, 10ˋ3 to <10ˋ2, and 10ˋ4 to <10ˋ3 in 15 (6%), 71 (26%), 109 (40%), and 77 (28%) patients, respectively. Median duration of complete remission (DoR) was 18.5 months (95% confidence interval [CI], 11.9每27.2), median relapse-free survival (RFS) was 12.4 months (95% CI, 10.0每19.0) and median overall survival (OS) was 32.5 months (95% CI, 23.6每48.0). Lower baseline MRD level (Pˋ≒ˋ.0003) and white blood cell count <30,000/米L at diagnosis (Pˋ≒ˋ.0053) were strong predictors for better RFS and DoR. Allogeneic hematopoietic stem cell transplantation (alloHSCT) was associated with longer RFS (hazard ratio [HR], 0.59; 95% CI, 0.41每0.84) and DoR (HR, 0.43; 95% CI, 0.29每0.64); the association with OS was not significant (HR, 0.72; 95% CI, 0.50每1.05). Discussion: In conclusion, RFS, DoR, and OS are relatively short in patients with MRD-positive ALL, particularly at higher MRD levels. AlloHSCT may improve survival but has limitations. Alternative approaches are needed to improve outcomes in MRD-positive ALL. GRAPHICAL ABSTRAC
%U https://www.tandfonline.com/doi/full/10.1080/16078454.2019.1567654