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Implication of Post-Induction Minimal Residual Disease in the Management of Pediatric Acute Lymphoblastic Leukemia in
Waqar Mushtaq1, Saadia Anwar2, Safwan Ahmad3
1Hematology and Oncology, University of Child Health Sciences, Lahore, PAK.
Insights
Minimal residual disease (MRD) measurement is crucial for pediatric acute lymphoblastic leukemia (ALL) treatment. Day 29 MRD evaluation effectively predicts treatment response in resource-limited settings, correlating with interim assessments.
Area of Science:
- Pediatric Hematology Oncology
- Leukemia Research
- Clinical Trial Analysis
Background:
- Minimal residual disease (MRD) is the most powerful tool for assessing treatment response in pediatric acute lymphoblastic leukemia (ALL).
- Effective MRD measurement is critical for optimizing treatment strategies and improving patient outcomes.
Purpose of the Study:
- To evaluate the impact of post-induction Day 29 MRD assessment on pediatric ALL management.
- To assess the correlation between Day 29 MRD and interim Day 8/15 bone marrow assessments in a resource-limited setting.
Main Methods:
- A prospective analytical study included 578 newly diagnosed pediatric ALL patients (ages 1-16).
- MRD was assessed on Day 29 post-induction and interim bone marrow evaluations were performed on Days 8/15, following the UKALL-2019 protocol.
- Flow cytometry was used for MRD assessment.
Main Results:
- A total of 578 patients were analyzed, with a majority being males (70.4%) and in the 5-10 year age group (56.0%).
- Pre-B ALL was diagnosed in 81.0% and pre-T ALL in 19.0% of patients.
- Post-induction Day 29 MRD was negative (<0.01%) in 85.6% of patients, correlating with continued standard treatment.
- A positive Day 29 MRD (>0.01%) was observed in 14.4% of patients, necessitating treatment escalation.
Conclusions:
- Achieving negative MRD post-induction indicates significant treatment response in pediatric ALL.
- Day 29 MRD assessment strongly correlates with interim bone marrow evaluations.
- Day 29 MRD is proposed as a cost-effective tool for treatment response evaluation in resource-limited settings.
Background:
Minimal residual disease (MRD) measurement in pediatric acute lymphoblastic leukemia (ALL) is the most powerful tool for treatment response assessment.
Objective:
This study aims to assess the implications of post-induction Day 29 MRD evaluation in the management of pediatric ALL within a resource-limited setting and its correlation with interim Day 8/15 bone marrow assessment.
Materials And Methods:
A prospective analytical study was conducted at the pediatric hematology oncology department from January 1, 2022, to December 31, 2022. Flowcytometry-based newly diagnosed ALL patients aged 1-16 years were included. MRD assessment on Day 29 of induction and interim bone marrow evaluations on Day 8/15 were performed according to the UKALL-2019 protocol.
Results:
Out of 578 patients, 407 (70.4%) were males, and 171 (29.6%) were females. The predominant age group was 5-10 years, including 324 (56.0%) patients. Flow cytometry revealed pre-B ALL in 468 (81.0%) and pre-T ALL in 110 (19.0%). High-risk patients receiving four-drug induction numbered 379 (65.6%), while 199 (34.4%) were standard risk. Interim bone marrow response was M2 in 502 (86.9%) and M3 in 73 (12.6%). Post-induction Day 29 MRD was < 0.01% (negative) in 495 (85.6%) patients who continued the same regimen, and >0.01% (positive) in 83 (14.4%) requiring treatment escalation. Among those with M3 interim marrow response, 42 (7.3%) were high-risk and MRD-positive. Induction mortality occurred in 32 (5.5%) patients, and treatment abandonment occurred in 46 (8.0%).
Conclusion:
Our study has demonstrated significant induction remission response in ALL by achieving negative MRD, which correlates strongly with interim bone marrow assessment, proposing Day 29 MRD as a single best cost-effective tool for response evaluation in resource-limited settings.
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