Measurable residual disease in pediatric acute myeloid leukemia: a systematic review
W H Segerink1, V de Haas1, G J L Kaspers1,2
1Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, Utrecht 3584CS, The Netherlands.
Abstract:
Introduction: A systematic review was performed to assess the prognostic value of Measurable Residual Disease (MRD) during treatment, for relapse and overall survival in pediatric acute myeloid leukemia (AML).Areas covered: A systematic search of available literature was performed to identify original full-text articles concerning MRD as prognostic for relapse and survival in pediatric AML. Thirteen studies were included, and in all studies, MRD positivity during treatment was associated with worse clinical outcome. MRD positivity was significantly associated with a higher probability of relapse in eleven studies. However, MRD negativity does not exclude the possibility of relapse in pediatric AML, while positivity early during therapy does not exclude cure.Expert opinion: MRD positivity during treatment has emerged as the most powerful prognostic factor in pediatric AML concerning relapse and overall survival and is useful for risk-group adapted treatment. Future studies should identify the optimal time-point(s) for MRD measurements and the optimal technique, to further improve its prognostic significance.
Insights
Measurable Residual Disease (MRD) monitoring during treatment is crucial for predicting relapse and survival in pediatric acute myeloid leukemia (AML). MRD positivity indicates a worse outcome, guiding risk-adapted therapy for better patient management.
Area of Science:
- Pediatric Hematology Oncology
- Clinical Cancer Research
Background:
- Measurable Residual Disease (MRD) is increasingly recognized as a key factor in acute myeloid leukemia (AML) prognosis.
- Accurate prognostic indicators are essential for tailoring treatment strategies in pediatric AML.
Purpose of the Study:
- To systematically review and assess the prognostic value of MRD during treatment for relapse and overall survival in pediatric AML.
- To evaluate the utility of MRD monitoring in risk-group stratification for pediatric AML patients.
Main Methods:
- A systematic literature search was conducted to identify original full-text articles on MRD in pediatric AML.
- Thirteen relevant studies were included in the systematic review.
Main Results:
- MRD positivity during treatment was consistently associated with worse clinical outcomes across all included studies.
- MRD positivity significantly correlated with a higher probability of relapse in eleven studies.
- MRD negativity does not rule out relapse, and early MRD positivity does not preclude cure.
Conclusions:
- MRD positivity during treatment is a powerful prognostic factor for relapse and survival in pediatric AML.
- MRD monitoring is valuable for guiding risk-group adapted treatment strategies.
- Further research is needed to optimize MRD measurement time-points and techniques for enhanced prognostic significance.
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