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Combined Early Steroid Response and MRD Improve Risk Stratification in Pediatric Acute Lymphoblastic Leukemia: The
Wenxin Ou1, Yi Yu1, Xiaohua Zhu1
1Department of Hematology and Oncology, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China.
European Journal of Haematology
|May 18, 2026
Summary
Early dexamethasone response combined with minimal residual disease (MRD) status refines risk stratification in pediatric acute lymphoblastic leukemia (ALL). This four-quadrant approach identifies patients at higher risk of relapse, complementing MRD-based assessments.
Area of Science:
- Pediatric Oncology
- Hematology
- Clinical Research
Background:
- Minimal residual disease (MRD) is a key prognostic factor in pediatric acute lymphoblastic leukemia (ALL).
- Early steroid response is also recognized as a predictor of treatment outcome.
Purpose of the Study:
- To evaluate if early dexamethasone response offers additional prognostic value beyond MRD.
- To determine if integrating both markers improves risk stratification in pediatric ALL.
Main Methods:
- Retrospective analysis of 312 pediatric ALL patients treated under the CCCG-ALL-2015 protocol.
- Classification of Day 5 steroid response as dexamethasone good response (DGR) or poor response (DPR).
- Bone marrow MRD assessment on Days 19 and 46, combined with steroid response into a four-quadrant model (DGR/MRD-, DGR/MRD+, DPR/MRD-, DPR/MRD+) to analyze event-free survival (EFS) and cumulative incidence of relapse (CIR).
Main Results:
- Day 46 MRD independently predicted inferior EFS (HR=2.429).
- The four-quadrant classification showed significant differences in EFS across groups.
- Compared to DGR/MRD-, other quadrants (DGR/MRD+, DPR/MRD-, DPR/MRD+) demonstrated significantly increased event risks in multivariable analysis.
Conclusions:
- MRD kinetics are crucial for identifying patients with delayed clearance or persistent positivity, indicating higher relapse risk.
- A four-quadrant framework integrating early steroid response and MRD status can complement MRD-based assessments.
- This integrated approach refines risk stratification by identifying clinically significant discordant subgroups in pediatric ALL.
