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Modvig, S; Madsen, H O; Siitonen, S M; Rosthøj, S; Tierens, A; Juvonen, V; Osnes, L T N; Vålerhaugen, H; Hultdin, M; Thörn, I; Matuzeviciene, R; Stoskus, M; Marincevic, M; Fogelstrand, L; Lilleorg, A; Toft, N; Jónsson, O G; Pruunsild, K; Vaitkeviciene, G; Vettenranta, K; Lund, B; Abrahamsson, J; Schmiegelow, K; Marquart, H V
Leukemia, 06/2019, Letnik: 33, Številka: 6Journal Article
Minimal residual disease (MRD) measured by PCR of clonal IgH/TCR rearrangements predicts relapse in T-cell acute lymphoblastic leukemia (T-ALL) and serves as risk stratification tool. Since 10% of patients have no suitable PCR-marker, we evaluated flowcytometry (FCM)-based MRD for risk stratification. We included 274 T-ALL patients treated in the NOPHO-ALL2008 protocol. MRD was measured by six-color FCM and real-time quantitative PCR. Day 29 PCR-MRD (cut-off 10 ) was used for risk stratification. At diagnosis, 93% had an FCM-marker for MRD monitoring, 84% a PCR-marker, and 99.3% (272/274) had a marker when combining the two. Adjusted for age and WBC, the hazard ratio for relapse was 3.55 (95% CI 1.4-9.0, p = 0.008) for day 29 FCM-MRD ≥ 10 and 5.6 (95% CI 2.0-16, p = 0.001) for PCR-MRD ≥ 10 compared with MRD < 10 . Patients stratified to intermediate-risk therapy on day 29 with MRD 10 -<10 had a 5-year event-free survival similar to intermediate-risk patients with MRD < 10 or undetectable, regardless of method for monitoring. Patients with day 15 FCM-MRD < 10 had a cumulative incidence of relapse of 2.3% (95% CI 0-6.8, n = 59). Thus, FCM-MRD allows early identification of patients eligible for reduced intensity therapy, but this needs further studies. In conclusion, FCM-MRD provides reliable risk prediction for T-ALL and can be used for stratification when no PCR-marker is available.
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