Feasibility of treating post-transplantation minimal residual disease in children with acute leukemia

Nirali N. Shah, Michael J Borowitz, Nancy C. Robey, Christopher Gamper, Heather Symons, David M. Loeb, Alan S. Wayne, Allen R Chen

Research output: Contribution to journalArticle

Abstract

Outcomes are poor for patients with hematologic malignancies who experience overt relapse after allogeneic hematopoietic stem cell transplantation (HCT). Data on outcomes of post-transplantation minimal residual disease (MRD) are limited. In this single-institution, retrospective cohort analysis of children with acute leukemia and myelodysplastic syndrome, we document the pattern of relapse with a primary focus on outcomes of post-transplantation MRD. Forty of 93 patients (43%) who underwent a first allogeneic HCT and had systematic pretransplantation and post-transplantation MRD evaluations at +30, +60, +90, +180 days and +1 and +2 years post-transplantation experienced relapse. The median time to relapse was 4.8 months post-transplantation, with a median survival of 4 months post-relapse. Despite frequent, systematic, routine post-HCT disease restaging evaluation, 31 patients (78%) presented with overt disease at the time of relapse. Seven patients with acute leukemia who had post-transplantation MRD presented at a median of 1 month post-transplantation. Owing to rapid disease progression or treatment-related mortality, there was no improvement in survival in those patients whose leukemia was detected in a state of MRD post-transplantation. Our results suggest that early intervention strategies targeting post-transplantation MRD for relapse prevention in acute leukemia may not be feasible.

Original languageEnglish (US)
Pages (from-to)1000-1007
Number of pages8
JournalBiology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation
Volume20
Issue number7
DOIs
Publication statusPublished - 2014

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Keywords

  • Allogeneic hematopoietic cell transplantation
  • Leukemia
  • Minimal residual disease
  • Pediatrics
  • Relapse

ASJC Scopus subject areas

  • Transplantation
  • Hematology

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