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Significance of minimal residual disease in pediatric mixed phenotype acute leukemia: a multicenter cohort study
Authors
Viviane C. Cahen
Terri Guinipero
+13 more
Dragos C. Luca
Jemily Malvar
Matthew J. Oberley
Etan Orgel
Maurice R.G. O’Gorman
Jyotinder N. Punia
Karen R. Rabin
Sunil S. Raikar
Reuven J. Schore
Alix E. Seif
Richard Sposto
Gerald B. Wertheim
William G. Woods
Publication date
1 July 2020
Publisher
Health Sciences Research Commons
Abstract
© 2020, The Author(s), under exclusive licence to Springer Nature Limited. The rarity of mixed phenotype acute leukemia (MPAL) has precluded adequate data to incorporate minimal residual disease (MRD) monitoring into therapy. Fluidity in MPAL classification systems further complicates understanding its biology and outcomes; this includes uncertainty surrounding the impact of shifting diagnostic requirements even between iterations of the World Health Organization (WHO) classification. Our primary objective was to address these knowledge gaps. To do so, we analyzed clinicopathologic features, therapy, MRD, and survival in a centrally-reviewed, multicenter cohort of MPAL uniformly diagnosed by the WHO classification and treated with acute lymphoblastic leukemia (ALL) regimens. ALL induction therapy achieved an EOI MRD negative (\u3c0.01%) remission in most patients (70%). EOI MRD positivity was predictive of 5-year EFS (HR = 6.00, p \u3c 0.001) and OS (HR = 9.57, p = 0.003). Patients who cleared MRD by EOC had worse survival compared with those EOI MRD negative. In contrast to adults with MPAL, ALL therapy without transplantation was adequate to treat most pediatric patients. Earlier MRD clearance was associated with better treatment success and survival. Prospective trials are now necessary to validate and refine MRD thresholds within the pediatric MPAL population and to identify salvage strategies for those with poor predicted survival
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George Washington University: Health Sciences Research Commons (HSRC)
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Last time updated on 03/12/2020