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ORIGINAL ARTICLE
Korean J Pediatr 2010 November;53(11) :957-964.
doi:https://doi.org/10.3345/kjp.2010.53.11.957
Prognostic significance of minimal residual disease detected by a simplified flow cytometric assay during remission induction chemotherapy in children with acute lymphoblastic leukemia
Kyung Nam Koh (Koh KN)1, Meerim Park (Park Mr)1, Bo Eun Kim (Kim BE)1, Ho Joon Im (Im HJ)1, Chan-Jeoung Park (Park CJ)2, Seongsoo Jang (Jang Ss)2, Hyun Sook Chi (Chi HS)2, Jong Jin Seo (Seo JJ)1
1Division of Pediatric Hematology/Oncology, Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
2Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
Corresponding Author: Jong Jin Seo ,Email: jjseo@amc.seoul.kr
Copyright © 2010 by The Korean Pediatric Society
ABSTRACT
Purpose : Our study attempted to determine the prognostic significance of minimal residual disease (MRD) detected by a simplified flow cytometric assay during induction chemotherapy in children with B-cell acute lymphoblastic leukemia (B-ALL). Methods : A total of 98 patients were newly diagnosed with precursor B-ALL from June 2004 to December 2008 at the Asan Medical Center (Seoul, Korea). Of those, 37 were eligible for flow cytometric MRD study analysis on day 14 of their induction treatment. The flow cytometric MRD assay was based on the expression intensity of CD19/ CD10/CD34 or aberrant expression of myeloid antigens by bone marrow nucleated cells. Results : Thirty-five patients (94.6%) had CD19-positive leukemic cells that also expressed CD10 and/or CD34, and 18 (48.6%) had leukemic cells with aberrant expression of myeloid antigens. Seven patients with 1% leukemic cells on day 14 had a significantly lower relapsefree survival (RFS) compared to the 30 patients with lower levels (42.9 % [18.7%] vs. 92.0% [5.4%], P=0.004). Stratification into 3 MRD groups (1%, 0.1-1%, and <0.1%) also showed a statistically significant difference in RFS (42.9% [18.7%] vs. 86.9% [8.7%] vs. 100%, P= 0.013). However, the MRD status had no significant influence on overall survival. Multivariate analysis demonstrated that the MRD level on day 14 was an independent prognostic factor with borderline significance. Conclusion : An MRD assay using simplified flow cytometry during induction chemotherapy may help to identify patients with B-ALL who have an excellent outcome and patients who are at higher risk for relapse.
Keywords: Lymphoblastic leukemia | Acute | Childhood | Minimal residual disease | Flow cytometry
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