Measurable residual disease study through three different methods can anticipate relapse and guide pre-emptive therapy in childhood acute myeloid leukemia

• Eduardo Ramos Elbal ^[1] ; José Luis Fuster ^[1] ; José Antonio Campillo ^[2] ; Ana María Galera ^[1] ; Mar Bermúdez Cortés ^[1] ; María Esther Llinares ^[1] ; Irene Jiménez ^[1] ; Mercedes Plaza ^[1] ; Helios Martínez Banaclocha ^[2] ; José Antonio Galián ^[2] ; Miguel Blanquer Blanquer ^[3] ; María Victoria Martínez Sánchez ^[2] ; Manuel Muro ^[2] ; Alfredo Minguela ^[2]
  1. [1] Servicio de Oncohematología Pediátrica, Clínica Hospital Universitario Virgen de la Arrixaca e Instituto de Investigación Biomédica de Murcia Pascual Parrilla (IMIB), 30120, Murcia, España
  2. [2] Servicio de Inmunología, Clínica Hospital Universitario Virgen de la Arrixaca e Instituto de Investigación Biomédica de Murcia Pascual Parrilla (IMIB), 30120, Murcia, España
  3. [3] Servicio de Hematología, Clínica Hospital Universitario Virgen de la Arrixaca e Instituto de Investigación Biomédica de Murcia Pascual Parrilla (IMIB), 30120, Murcia, España

  Mostrar afiliaciones +
• Localización: Clinical & translational oncology, ISSN 1699-048X, Vol. 25, Nº. 5 (May), 2023, págs. 1446-1454
• Idioma: inglés
• Texto completo no disponible (Saber más ...)
• Resumen

  • Purpose Although outcomes of children with acute myeloid leukemia (AML) have improved over the last decades, around one-third of patients relapse. Measurable (or minimal) residual disease (MRD) monitoring may guide therapy adjustments or pre-emptive treatments before overt hematological relapse.

    Methods In this study, we review 297 bone marrow samples from 20 real-life pediatric AML patients using three MRD monitoring methods: multiparametric flow cytometry (MFC), fluorescent in situ hybridization (FISH) and polymerase chain reaction (PCR).

    Results Patients showed a 3-year overall survival of 73% and a 3-year event-free survival of 68%. Global relapse rate was of 25%. All relapses were preceded by the reappearance of MRD detection by: (1) MFC (p = 0.001), (2) PCR and/or FISH in patients with an identifiable chromosomal translocation (p = 0.03) and/or (3) one log increase of Wilms tumor gene 1 (WT1) expression in two consecutive samples (p = 0.02). The median times from MRD detection to relapse were 26, 111, and 140 days for MFC, specific PCR and FISH, and a one log increment of WT1, respectively.

    Conclusions MFC, FISH and PCR are complementary methods that can anticipate relapse of childhood AML by weeks to several months. However, in our series, pre-emptive therapies were not able to prevent disease progression. Therefore, more sensitive MRD monitoring methods that further anticipate relapse and more effective pre-emptive therapies are needed.