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. 2021 Jul;37(3):366-371.
doi: 10.1007/s12288-020-01354-0. Epub 2020 Sep 13.

Complete Peripheral Blast Clearance is Superior to the Conventional Cut-Off of 1000/µL in Predicting Relapse in Pediatric Pre-B Acute Lymphoblastic Leukemia

Thomas Cherian  1 , Rikki John  1 , Leenu Lizbeth Joseph  1 , Hema N Srinivasan  1 , Deepthi Boddu  1 , Tulasi Geevar  2 , Leni Grace Mathew  1 , Sidharth Totadri  1
Affiliations

Complete Peripheral Blast Clearance is Superior to the Conventional Cut-Off of 1000/µL in Predicting Relapse in Pediatric Pre-B Acute Lymphoblastic Leukemia

Thomas Cherian et al. Indian J Hematol Blood Transfus. 2021 Jul.

Abstract

Risk-stratification has contributed to a dramatic improvement in survival in pediatric acute lymphoblastic leukemia (ALL). This study evaluated the utility of prephase response and day 15 bone marrow when a minimal residual disease (MRD) assessment was available. A file review of children aged ≤ 15 years diagnosed with precursor-B ALL from 2014 to 2019 was performed. The protocol used for risk stratification and treatment was based on a UKALL-2003 backbone. All patients received one week of prephase therapy comprised of intravenous dexamethasone in the first 48 h followed by oral prednisolone. The median age of the 255 patients in the study was 5 years. Following the prephase, the peripheral blood absolute blast count was 0 and ≥ 1000/µL blasts in 141 (56%) and 29 (11%), respectively. Ten of 199 (5%) patients with an evaluable day 15 bone marrow had M3 status. At the end of induction, 30 (12%), 127 (50%) and 98 (38%) patients belonged to the standard-risk, intermediate-risk and high-risk (HR) groups, respectively. An M3 day15 bone marrow was the sole reason for escalation in three (3%) of the patients in the HR group. A lack of complete clearance of peripheral blood blasts post-prephase [HR: 2.45 (1.04-5.75), p = 0.040] and a positive MRD [HR: 3.00 (1.28-7.02), p = 0.011] independently predicted risk of relapse. Complete blast clearance is superior to the traditional cut-off of 1000/µL in predicting relapse. The role of a day 15 bone marrow morphology is diminished when an end of induction MRD is available.

Keywords: Childhood leukemia; Early bone marrow; Poor prednisolone response; Prognostic marker; Rapid early response.

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Conflict of interest statement

Conflict of interestNone of the authors have anything to disclose.

Figures

Fig. 1
Fig. 1
Flow diagram illustrating inclusion of eligible patients for the study
Fig. 2
Fig. 2
Comparison of relapse-free survival using different absolute peripheral blood blast count cut-offs to define steroid prephase response (solid line: 0 /µL, dashed line: 1–999 /µL and dotted line: ≥ 1000 /µL). Patients with complete peripheral blast clearance had significantly better survival compared to the other groups
See this image and copyright information in PMC

References

    1. Hunger SP, Mullighan CG. Acute Lymphoblastic Leukemia in Children. N Engl J Med. 2015;373(16):1541–1552. doi: 10.1056/NEJMra1400972. - DOI - PubMed
    1. Pui C-H, Yang JJ, Hunger SP, Pieters R, Schrappe M, Biondi A, et al. Childhood acute lymphoblastic leukemia: progress through collaboration. J Clin Oncol Off J Am Soc Clin Oncol. 2015;33(27):2938–2948. doi: 10.1200/JCO.2014.59.1636. - DOI - PMC - PubMed
    1. Athale UH, Gibson PJ, Bradley NM, Malkin DM, Hitzler J, POGO MRD Working Group (2016) Minimal residual disease and childhood leukemia: standard of care recommendations from the pediatric oncology group of ontario MRD working group. Pediatr Blood Cancer 63(6):973–82 - PubMed
    1. Vora A, Goulden N, Wade R, Mitchell C, Hancock J, Hough R, et al. Treatment reduction for children and young adults with low-risk acute lymphoblastic leukaemia defined by minimal residual disease (UKALL 2003): a randomised controlled trial. Lancet Oncol. 2013;14(3):199–209. doi: 10.1016/S1470-2045(12)70600-9. - DOI - PubMed
    1. Vora A, Goulden N, Mitchell C, Hancock J, Hough R, Rowntree C, et al. Augmented post-remission therapy for a minimal residual disease-defined high-risk subgroup of children and young people with clinical standard-risk and intermediate-risk acute lymphoblastic leukaemia (UKALL 2003): a randomised controlled trial. Lancet Oncol. 2014;15(8):809–818. doi: 10.1016/S1470-2045(14)70243-8. - DOI - PubMed

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