Minimal residual disease level determined by flow cytometry provides reliable risk stratification in adults with...

Area of Science:

• Hematology
• Oncology
• Clinical Immunology

Background:

• Minimal residual disease (MRD) is a critical prognostic indicator in acute lymphoblastic leukaemia (ALL).
• Prognostic data for MRD in adult T-cell ALL (T-ALL) are limited, especially using flow cytometry (FCM).
• Previous studies primarily relied on molecular methods for MRD assessment in T-ALL.

Purpose of the Study:

• To evaluate the prognostic significance of multiparameter FCM-based MRD at the end of induction (EOI-MRD) in adult T-ALL.
• To determine if EOI-MRD is an independent predictor of relapse and survival in adult T-ALL patients.
• To assess the utility of EOI-MRD in predicting post-transplant relapse in patients undergoing allogeneic haematopoietic stem cell transplantation (allo-HSCT).

Main Methods:

• Retrospective analysis of 94 adult T-ALL patients.
• Detection of MRD using six- to eight-colour multiparameter FCM at the end of induction therapy.
• Statistical analysis including Kaplan-Meier survival estimates, log-rank tests, and multivariate Cox regression.

Main Results:

• EOI-MRD positive patients showed significantly higher cumulative incidence of relapse (CIR) (87.6% vs. 38.8%) and lower relapse-free survival (RFS) (5.4% vs. 61.0%) and overall survival (OS) (32.7% vs. 69.7%) compared to MRD negative patients.
• In patients undergoing allo-HSCT, EOI-MRD positivity predicted a higher 2-year CIR (68.2% vs. 4.0%).
• Multivariate analysis confirmed EOI-MRD as an independent prognostic factor for CIR, RFS, and OS.

Conclusions:

• End-of-induction MRD assessment by FCM is a robust and independent prognostic marker for relapse and survival in adult T-ALL.
• FCM-based EOI-MRD can identify T-ALL patients at high risk of relapse post-allo-HSCT.
• This method provides valuable prognostic information to guide treatment strategies in adult T-ALL.