Flow-cytometric vs. -morphologic assessment of remission in childhood acute lymphoblastic leukemia: a report from the Children's Oncology Group (COG)

Leukemia
Sumit GuptaBrent L Wood

Abstract

Minimal residual disease (MRD) after initial therapy is integral to risk stratification in B-precursor and T-precursor acute lymphoblastic leukemia (B-ALL, T-ALL). Although MRD determines depth of remission, remission remains defined by morphology. We determined the outcomes of children with discordant assessments of remission by morphology vs. flow cytometry using patients age 1-30.99 years enrolled on Children's Oncology Group ALL trials who underwent bone marrow assessment at the end of induction (N = 9350). Morphologic response was assessed locally as M1 (<5% lymphoblasts; remission), M2 (5-25%), or M3 (>25%). MRD was centrally measured by flow cytometry. Overall, 19.8% of patients with M2/M3 morphology had MRD < 5%. M1 with MRD ≥ 5% was less common in B-ALL (0.9%) than T-ALL (6.9%; p < 0.0001). In B-ALL, M1/MRD ≥ 5% was associated with superior 5-year event-free survival (EFS) than M2/MRD ≥ 5% (59.1% ± 6.5% vs. 39.1% ± 7.9%; p = 0.009), but was inferior to M1/MRD < 5% (87.1% ± 0.4%; p < 0.0001). MRD levels were higher in M2/MRD ≥ 5% than M1/MRD ≥ 5% patients. In T-ALL, EFS was not significantly different between M1/MRD ≥ 5% and M2/MRD ≥ 5%. Patients with morphologic remission but MRD ≥ 5% have outcomes similar to those who...Continue Reading

References

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Citations

Jul 3, 2018·Leukemia & Lymphoma·Maria AmpatzidouSophia Polychronopoulou
Dec 12, 2019·Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology·Kelly W MaloneyNaomi J Winick
Feb 25, 2020·Cytometry. Part a : the Journal of the International Society for Analytical Cytology·Minh DoanJulie Irving
Nov 18, 2018·Current Hematologic Malignancy Reports·Franklin Fuda, Weina Chen
Nov 26, 2020·American Journal of Clinical Pathology·Sindhu Cherian, Lorinda A Soma
Jul 27, 2021·Clinics in Laboratory Medicine·John Kim Choi, Paul E Mead
Sep 2, 2021·Blood Advances·Paraskevi DiamantiAllison Blair

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Datasets Mentioned

BETA
AALL0434

Methods Mentioned

BETA
flow cytometry
PCR

Clinical Trials Mentioned

NCT00482352
NCT01142427
NCT00103285
NCT00075725
NCT00408005

Software Mentioned

R
SAS®

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