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Updated: Apr 19, 2026
Detection of Residual Donor Erythroid Progenitor Cells after Hematopoietic Stem Cell Transplantation for Patients with Hemoglobinopathies
Published on: September 6, 2017
Follow-up of post-transplant minimal residual disease and chimerism in childhood lymphoblastic leukaemia: 90 d to
Cécile Pochon1, Emmanuel Oger, Gérard Michel
1Department of Paediatric Haematology/oncology, University Hospital of Nancy, Nancy, France.
Insights
Minimal Residual Disease (MRD) monitoring post-pediatric acute lymphoblastic leukemia (ALL) transplant is crucial. Early MRD detection aids in predicting relapse and guiding interventions, improving overall survival rates.
Area of Science:
- Hematology
- Immunology
- Pediatric Oncology
Background:
- Relapse is a primary cause of treatment failure in pediatric acute lymphoblastic leukemia (ALL) post-transplantation.
- Immune interventions are being explored to improve outcomes in these high-risk patients.
Purpose of the Study:
- To investigate the feasibility of immune intervention in children with ALL in remission after myeloablative conditioning.
- To assess the prognostic value of Minimal Residual Disease (MRD) monitoring for predicting relapse and guiding therapy.
Main Methods:
- A prospective national study involving 133 children undergoing ALL transplantation (2005-2008).
- Minimal Residual Disease (MRD) was measured using gene rearrangements at multiple time points pre- and post-transplant.
- Ciclosporin was discontinued early, with donor lymphocyte infusions (DLI) planned for MRD-positive patients.
Main Results:
- Overall survival (OS) was 62.07% for the cohort.
- Patients cleared of MRD had significantly higher OS (52.3%) compared to those with persistent MRD (14.3%).
- Pre-transplant MRD and ciclosporin duration independently predicted relapse; chimerism kinetics did not.
Conclusions:
- Early MRD monitoring up to 90 days post-transplant is a valuable prognostic tool.
- MRD status is a key factor influencing survival and guiding therapeutic interventions in pediatric ALL.
- The study highlights the importance of MRD assessment in optimizing post-transplant strategies for ALL.
Abstract:
Relapse after transplantation is a major cause of treatment failure in paediatric acute lymphoblastic leukaemia (ALL). Here, we report the findings of a prospective national study designed to investigate the feasibility of immune intervention in children in first or subsequent remission following myeloablative conditioning. This study included 133 children who received a transplant for ALL between 2005 and 2008. Minimal Residual Disease (MRD) based on T cell receptor/immunoglobulin gene rearrangements was measured on days -30, 30, 90 and 150 post-transplantation. Ciclosporin treatment was rapidly discontinued and donor lymphocyte infusions (DLI) were programmed for patients with a pre- or post-transplant MRD status ≥10(-3) . Only nine patients received DLI. Pre- and post-transplant MRD status, and the duration of ciclosporin were independently associated with 5-year overall survival (OS), which was 62·07% for the whole cohort. OS was substantially higher in patients cleared of MRD than in those with persistent MRD (52·3% vs. 14·3%, respectively). Only pre-transplant MRD status (Hazard Ratio 2·57, P = 0·04) and duration of ciclosporin treatment (P < 0·001) were independently associated with relapse. The kinetics of chimerism were not useful for predicting relapse, whereas MRD monitoring up to 90 d post-transplantation was a valuable prognostic tool to guide therapeutic intervention.
