Post-Induction Minimal Residual Disease in Pediatric Pre-B-Cell Acute Lymphoblastic Leukemia: A Step Towards
Ibrahim Ghemlas1, Ibrahim Al-Ebaid1, Khawar Siddiqui1
1Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
Insights
Minimal residual disease (MRD) after induction therapy is a key predictor of survival in pediatric acute lymphoblastic leukemia (ALL). Early detection of MRD significantly impacts patient outcomes and guides treatment decisions.
Area of Science:
- Pediatric Oncology
- Hematology
- Cancer Research
Background:
- Acute lymphoblastic leukemia (ALL) is the most common pediatric cancer globally and in Saudi Arabia.
- Minimal residual disease (MRD) is a critical prognostic indicator for relapse risk and long-term outcomes in ALL.
- MRD monitoring is essential for tailoring risk-adapted therapies in ALL patients.
Purpose of the Study:
- To investigate the impact of MRD on survival outcomes in pediatric ALL patients.
- To assess the role of post-induction and post-consolidation MRD in predicting patient prognosis.
- To identify significant risk factors influencing survival in pediatric ALL.
Main Methods:
- Retrospective review of medical records for 108 pediatric ALL patients (age ≤ 14 years).
- Patients were treated between January 2016 and December 2018.
- Outcomes were assessed based on MRD status at post-induction and post-consolidation phases.
Main Results:
- Overall survival (OS) was 89.2±3.1%, with significantly lower OS in post-induction MRD-positive cases (74.2±8.6%) vs. MRD-negative cases (94.7±2.6%).
- Event-free survival (EFS) was also significantly poorer in post-induction MRD-positive cases (61.1±10.2%) vs. MRD-negative cases (92.1±3.1%).
- Post-induction MRD positivity was the only factor significantly associated with OS among all evaluated risk factors.
Conclusions:
- Post-induction MRD is a crucial factor influencing patient outcomes in pediatric ALL.
- Patients with positive post-induction MRD showed improved outcomes after consolidation therapy.
- No significant association was found between post-induction MRD and other traditional risk factors like age, gender, or cytogenetics.
Background:
Acute lymphoblastic leukemia (ALL) is the most common pediatric malignancy with an incidence of 30% of pediatric cancers across the world and 34% amongst Saudi children with cancers. Minimal residual disease (MRD) is considered the most important independent predictor in determining the risk of relapse and long-term outcomes in ALL patients and plays a pivotal role in guiding risk-adapted therapies. The aim of this research was to study the role of MRD on survival benefits in our patient population.
Methods:
We reviewed medical records of 108 pediatric (age ≤ 14 years) ALL patients treated between January 2016 and December 2018 at our center to assess if MRD and other associated risk factors affect the outcome of patients at post-induction and post-consolidation phases of the treatment protocols.
Results:
The median follow-up time in our cohort of patients was 75.6 months (95% confidence interval: 71.3 - 79.8 months). With a mortality rate of 10.2% (11 deaths out of 108 cases), overall survival (OS) of the whole cohort was 89.2±3.1%. OS was significantly lower in post-induction MRD-positive cases than in MRD-negative cases (74.2±8.6% vs. 94.7±2.6%, P = 0.006). It was worse among those patients who underwent consolidation therapy and had positive post-consolidation MRD. Event-free survival (EFS) was also significantly poor in post-induction MRD-positive cases (61.1±10.2% vs. 92.1±3.1%, P = 0.001). Twenty-seven patients who received consolidation therapy had the poorest EFS (P = 0.031). Amongst all the factors, including age at diagnosis, gender, white blood cell count, central nervous system status, risk group or cytogenetics, only post-induction MRD positivity was found to be significantly associated with OS.
Conclusion:
Post-induction MRD is one of the most important factors affecting the patient's outcome. Post-induction MRD-positive patients fared better after receiving consolidation therapy. No significant association was found between post-induction MRD and other risk factors.
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