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Acute Leukemias

Impact of pretransplant minimal residual disease after cord blood transplantation for childhood acute lymphoblastic leukemia in remission: an Eurocord, PDWP–EBMT analysis

Leukemia volume 26, pages 2455–2461 (2012)Cite this article

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Abstract

To address the prognostic value of minimal residual disease (MRD) before unrelated cord blood transplantation (UCBT) in children with acute lymphoblastic leukemia (ALL), we analyzed 170 ALL children transplanted in complete remission (CR) after myeloablative conditioning regimen. In all, 72 (43%) were in first CR (CR1), 77 (45%) in second CR (CR2) and 21 (12%) in third CR (CR3). The median interval from MRD quantification to UCBT was 18 days. All patients received single-unit UCBT. Median follow-up was 4 years. Cumulative incidence (CI) of day-60 neutrophil engraftment was 85%. CI of 4 years relapse was 30%, incidence being lower in patients with negative MRD before UCBT (hazard ratio (HR)=0.4, P=0.01) and for those transplanted in CR1 and CR2 (HR=0.3, P=0.002). Probability of 4 years leukemia-free survival (LFS) was 44%, (56, 44 and 14% for patients transplanted in CR1, CR2 and CR3, respectively (P=0.0001)). Patients with negative MRD before UCBT had better LFS after UCBT compared with those with positive MRD (54% vs 29%; HR=2, P=0.003). MRD assessment before UCBT for children with ALL in remission allows identifying patients at higher risk of relapse after transplantation. Approaches that may decrease relapse incidence in children given UCBT with positive MRD should be investigated to improve final outcomes.

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Acknowledgements

This study was funded in part by the Inserm grant TGIR0805. We thank Fernanda Volt, Wagnara Chaves and Chantal Kenzey for help with data collection.

AUTHOR CONTRIBUTIONS

AR, EG and VR designed the study, prepared and analyzed data. AR, EG, FL and VR wrote the paper; GM, J-HD, MC, FL, AC, CD, MM, JPH, MB, HB, MM, CP provided cases for the study; DP, RC and NK prepared and verified data, ML helped to analyze the data. All authors edited and approved the manuscript.

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Authors and Affiliations

  1. Eurocord, Hôpital Saint Louis APHP, University Paris VII IUH, Paris, France

    A Ruggeri, D Purtill, R Cunha, N Kabbara, E Gluckman & V Rocha

  2. Rome Transplant Network, University Tor Vergata, Rome, Italy

    A Ruggeri

  3. Hôpital d'Enfants de la Timone, Marseille, France

    G Michel

  4. Service d’Hématologie, Hôpital Robert Debré, APHP, Paris, France

    J-H Dalle

  5. Dipartimento di Oncoematologia Pediatrica, Ospedale Bambino Gesù, IRCSS, Università di Pavia, Roma, Italy

    M Caniglia & F Locatelli

  6. BMT Unit, Institute Portugues Oncologia, Porto, Portugal

    A Campos

  7. Servicio de Hematologia y Oncologia Pediátrica, Hospital Vall d'Hebron, Barcelona, Spain

    C D de Heredia

  8. Department Hematologie, Hotel Dieu, Nantes, France

    M Mohty

  9. Unidad de Hematología Pediátrica, Hospital Virgen del Rocio, Sevilla, Spain

    J M P Hurtado

  10. Department of Hematology, University Hospital for Children, Utrecht, The Netherlands

    M Bierings

  11. Centre de Cancérologie Charles-Bruneau, Ste-Justine Hospital, Montréal, Canada

    H Bittencourt

  12. Til, Sao Paolo, Brazil

    M Mauad

  13. Acute Leukemia Working Party, EBMT, Hopital Saint Antoine, Paris, France

    M Labopin

  14. Paediatric Diseases Working Party, EBMT, BMT Unit, St. Anna Kinderspital, Vienna, Austria

    C Peters

  15. Sirio Libanes Hospital and Cancer Children’s Hospital (ITACI), University of Sao Paulo, Sao Paulo, Brazil

    V Rocha

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  1. A Ruggeri
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Correspondence to A Ruggeri.

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Ruggeri, A., Michel, G., Dalle, JH. et al. Impact of pretransplant minimal residual disease after cord blood transplantation for childhood acute lymphoblastic leukemia in remission: an Eurocord, PDWP–EBMT analysis. Leukemia 26, 2455–2461 (2012). https://doi.org/10.1038/leu.2012.123

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