Satisfactory outcome after intensive chemotherapy with pragmatic use of minimal residual disease (MRD) monitoring in older patients with Philadelphia-negative B cell precursor acute lymphoblastic leukaemia: a Swedish registry-based study

Medical Oncology
Emma BergfeltHeléne Hallböök

Abstract

The introduction of minimal residual disease (MRD) monitoring, in the Swedish national guidelines for acute lymphoblastic leukaemia, was evaluated in 35 patients aged 46-79 years (median 61), who were diagnosed from 2007 to 2011 and treated with high-intensity, block-based chemotherapy (ABCDV/VABA induction). Both a high complete remission rate (91 %) and acceptable overall survival (OS) rate (47 %) at 5 years were achieved. MRD by flow cytometry was measured in 73 % of the patients reaching complete remission after the first course, but was omitted by the clinicians for eight patients who were either over 70 years of age or already met conventional high-risk criteria. Factors negatively influencing OS were age over 65 years and WHO status ≥2. MRD < 0.1 % after induction had positive impact on continuous complete remission but not on OS. Only five patients were allocated to allogeneic haematopoietic stem cell transplantation in first remission, mainly due to conventional high risk factors. Thus, use of intensive remission induction therapy is effective in a selection of older patients. In a population for whom the possibilities of treatment escalation are limited, the optimal role of MRD monitoring remains to be determined.

References

Aug 16, 2002·British Journal of Haematology·Helene HallböökBengt Smedmyr
Jan 7, 2009·Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology·Françoise HuguetHervé Dombret
Mar 24, 2012·Blood·Nicola GökbugetUNKNOWN German Multicenter Study Group for Adult Acute Lymphoblastic Leukemia
May 16, 2013·Blood·Nicola Gökbuget
Apr 18, 2014·Blood·Kheira BeldjordUNKNOWN Group for Research on Adult Acute Lymphoblastic Leukemia (GRAALL)
Nov 5, 2014·Cytometry. Part B, Clinical Cytometry·Chantal FossatUNKNOWN French Multicenter Study Groups for Pediatric and Adult ALL

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