Follow‐up of post‐transplant minimal residual disease and chimerism in childhood lymphoblastic leukaemia: 90 d to react. (19th December 2014)

• Record Type: Journal Article
• Authors: Pochon, Cécile; Oger, Emmanuel; Michel, Gérard; Dalle, Jean‐Hugues; Salmon, Alexandra; Nelken, Brigitte; Bertrand, Yves; Cavé, Hélène; Cayuela, Jean‐Michel; Grardel, Nathalie; Macintyre, Elizabeth; Margueritte, Geneviève; Méchinaud, Françoise; Rohrlich, Pierre; Paillard, Catherine; Demeocq, François; Schneider, Pascale; Plantaz, Dominique; Poirée, Marilyne; Eliaou, Jean‐François; Semana, Gilbert; Drunat, Séverine; Jonveaux, Philippe; Bordigoni, Pierre; Gandemer, Virginie
• Is Part Of: British journal of haematology. Volume 169:Number 2(2015:Apr.)
• Page Start: 249
• Page End: 261
• Publication Date: 2014-12-19
• Subjects: Hematology -- Periodicals; Blood -- Diseases -- Periodicals; 616.15
• DOI: 10.1111/bjh.13272
• Languages: English
• ISSNs: 0007-1048

Abstract

<abstract abstract-type="main" id="bjh13272-abs-0001"> <title>Summary</title> <p>Relapse after transplantation is a major cause of treatment failure in paediatric acute lymphoblastic leukaemia (ALL). Here, we report the findings of a prospective national study designed to investigate the feasibility of immune intervention in children in first or subsequent remission following myeloablative conditioning. This study included 133 children who received a transplant for ALL between 2005 and 2008. Minimal Residual Disease (MRD) based on T cell receptor/immunoglobulin gene rearrangements was measured on days −30, 30, 90 and 150 post‐transplantation. Ciclosporin treatment was rapidly discontinued and donor lymphocyte infusions (DLI) were programmed for patients with a pre‐ or post‐transplant MRD status ≥10<sup>−3</sup>. Only nine patients received DLI. Pre‐ and post‐transplant MRD status, and the duration of ciclosporin were independently associated with 5‐year overall survival (OS), which was 62·07% for the whole cohort. OS was substantially higher in patients cleared of MRD than in those with persistent MRD (52·3% vs. 14·3%, respectively). Only pre‐transplant MRD status (Hazard Ratio 2·57, <italic>P</italic> = 0·04) and duration of ciclosporin treatment (<italic>P</italic> < 0·001) were independently associated with relapse. The kinetics of chimerism were not useful for predicting relapse, whereas MRD monitoring up to 90 d post‐transplantation was a valuable prognostic tool to guide therapeutic intervention.</p> </abstract>