Prognostic impact of minimal residual disease at the end of consolidation in NCI standard-risk B-lymphoblastic leukemia: A report from the Children’s Oncology Group

Rau RE, Dai Y, Devidas M, Rabin KR, Zweidler-McKay P, Angiolillo A, Schore RJ, Burke MJ, Salzer WL, Heerema NA, Carroll AJ, Winick NJ, Hunger SP, Raetz EA, Loh ML, Wood BL, Borowitz MJ. Prognostic impact of minimal residual disease at the end of consolidation in NCI standard-risk B-lymphoblastic leukemia: A report from the Children’s Oncology Group. Pediatr Blood Cancer. 2021 Apr;68(4):e28929. doi: 10.1002/pbc.28929. Epub 2021 Feb 9. PubMed PMID: 33559396; PubMed Central PMCID: PMC8808711.

The 5-year disease-free survival (DFS) of NCI high-risk (HR) B-lymphoblastic leukemia (B-ALL) patients with end of induction (EOI) MRD≥0.1% and end of consolidation (EOC) MRD≥0.01% is 39±7%, warranting consideration of hematopoietic stem cell transplant (HSCT). However, the impact of EOC MRD in NCI standard-risk (SR) B-ALL patient using COG regimens is unknown. We found that SR patients with MRD≥0.01% at both EOI and EOC have a 4-year DFS/overall survival of 72.9%±19.0%/91.7±10.8% versus 90.7%±2.9%/95.5±2.0% (P=0.0019/0.25) for those with EOI MRD≥0.01% and EOC MRD<0.01%. These data suggest that routine use of HSCT may not be warranted in EOC MRD≥0.01%SR patients.