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
StatePublished - 2014

Fingerprint

Residual Neoplasm
Leukemia
Transplantation
Recurrence
Hematopoietic Stem Cell Transplantation
Survival
Myelodysplastic Syndromes
Hematologic Neoplasms
Secondary Prevention
Disease Progression
Cohort Studies
Mortality

Keywords

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

ASJC Scopus subject areas

  • Transplantation
  • Hematology

Cite this

@article{c89a6afc721944b9baeaed9711e36f63,
title = "Feasibility of treating post-transplantation minimal residual disease in children with acute leukemia",
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.",
keywords = "Allogeneic hematopoietic cell transplantation, Leukemia, Minimal residual disease, Pediatrics, Relapse",
author = "Shah, {Nirali N.} and Borowitz, {Michael J} and Robey, {Nancy C.} and Christopher Gamper and Heather Symons and Loeb, {David M.} and Wayne, {Alan S.} and Chen, {Allen R}",
year = "2014",
doi = "10.1016/j.bbmt.2014.03.021",
language = "English (US)",
volume = "20",
pages = "1000--1007",
journal = "Biology of Blood and Marrow Transplantation",
issn = "1083-8791",
publisher = "Elsevier Inc.",
number = "7",

}

TY - JOUR

T1 - Feasibility of treating post-transplantation minimal residual disease in children with acute leukemia

AU - Shah, Nirali N.

AU - Borowitz, Michael J

AU - Robey, Nancy C.

AU - Gamper, Christopher

AU - Symons, Heather

AU - Loeb, David M.

AU - Wayne, Alan S.

AU - Chen, Allen R

PY - 2014

Y1 - 2014

N2 - 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.

AB - 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.

KW - Allogeneic hematopoietic cell transplantation

KW - Leukemia

KW - Minimal residual disease

KW - Pediatrics

KW - Relapse

UR - http://www.scopus.com/inward/record.url?scp=84902119213&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84902119213&partnerID=8YFLogxK

U2 - 10.1016/j.bbmt.2014.03.021

DO - 10.1016/j.bbmt.2014.03.021

M3 - Article

C2 - 24680975

AN - SCOPUS:84902119213

VL - 20

SP - 1000

EP - 1007

JO - Biology of Blood and Marrow Transplantation

JF - Biology of Blood and Marrow Transplantation

SN - 1083-8791

IS - 7

ER -