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Blood, Vol. 95 No. 3 (February 1), 2000:
pp. 790-794
Rapid molecular response during early induction chemotherapy
predicts a good outcome in childhood acute lymphoblastic
leukemia
E. Renate Panzer-Grümayer,
Monika Schneider,
Simon Panzer,
Karin Fasching, and
Helmut Gadner
From the Children's Cancer Research Institute and St. Anna
Kinderspital, and the Institute of Blood Group Serology, University of
Vienna, Vienna, Austria.
Early response to therapy is an independent prognostic factor in
childhood acute lymphoblastic leukemia. Although most patients have
rapid early responses, as detected by morphology, 15% to 20% of
patients have relapses. The authors evaluated residual disease by
molecular methods on day 15 of minimal residual disease (MRD) therapy
and compared these data with their recently established MRD-based risk
stratification, defined by MRD levels 5 weeks after induction treatment
and before consolidation. All 68 children treated according to current
Berlin-Frankfurt-Münster (BFM) protocols went into
morphologically complete remission after induction. There was a
significant difference in outcome between children with rapid disease
clearance and those with high levels of day-15 MRD
(P = .035). Among patients with high levels of day-15 MRD, only the MRD-based risk stratification was predictive of the outcome. All patients with negative or low day-15 MRD had excellent prognoses and were in the MRD-based low-risk group. Thus, after only 2 weeks of
treatment, the authors were able to identify a patient population of 20% who may benefit from the least intensive treatment.
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