Koji Nagafuji1, Toshihiro Miyamoto2, Tetsuya Eto3, Ryosuke Ogawa4, Hirokazu Okumura5, Ken Takase6, Noriaki Kawano7, Yasuhiko Miyazaki8, Tomoaki Fujisaki9, Atsushi Wake10, Yuju Ohno11, Toshiro Kurokawa12, Tomohiko Kamimura13, Yasushi Takamatsu14, Shouhei Yokota15, Koichi Akashi2. 1. Department of Medicine, Kurume University School of Medicine, Kurume, Japan. 2. Department of Hematology/Oncology, Kyushu University Hospital, Fukuoka, Japan. 3. Department of Hematology, Hamanomachi Hospital, Fukuoka, Japan. 4. Department of Hematology and Oncology, Japan Community Healthcare Organization Kyushu Hospital, Kitakyushu, Japan. 5. Department of Hematology, Toyama Prefectural Central Hospital, Toyama, Japan. 6. Department of Hematology and Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan. 7. Department of Hematology, Miyazaki Prefectural Hospital, Miyazaki, Japan. 8. Department of Hematology, Oita Prefectural Hospital, Oita, Japan. 9. Department of Hematology, Matsuyama Red Cross Hospital, Matsuyama, Japan. 10. Department of Hematology, Toranomon Hospital Kajigaya, Kawasaki, Japan. 11. Department of Hematology, Kitakyushu Municipal Medical Center, Kitakyushu, Japan. 12. Department of Hematology, Toyama Red Cross Hospital, Toyama, Japan. 13. Department of Hematology, HaraSanshin General Hospital, Fukuoka, Japan. 14. Division of Medical Oncology, Hematology and Infectious Diseases, Department of Internal Medicine, Fukuoka University Hospital, Fukuoka, Japan. 15. Kyoto Prefecture Government, Kyoto, Japan.
Abstract
OBJECTIVE: We investigated whether minimal residual disease (MRD) status in adult patients with Philadelphia chromosome (Ph)-negative acute lymphoblastic leukemia (ALL) is useful for decision on clinical indications for allogeneic hematopoietic stem cell transplantation (HSCT). METHODS: We prospectively monitored MRD after induction and consolidation therapy in adult patients with Ph-negative ALL. RESULTS: Among 103 adult ALL patients enrolled, 59 were Ph-negative, and MRD status was assessed in 51 patients. The probability of 3-year overall survival (OS) and disease-free survival (DFS) was 69% (95%CI 54-80) and 50% (95%CI 36-63), respectively. Patients who were MRD-negative after induction therapy (n = 15) had a significantly better 3-year DFS compared with those who were MRD-positive (n = 30; 73% vs 41%, P = 0.018). Patients who were MRD-positive after induction but became MRD-negative after consolidation chemotherapy C in the first course (n = 11) showed a significantly worse 3-year DFS compared with patients who were MRD-negative after induction chemotherapy A in the first course (45% vs 73%, P = 0.025). CONCLUSIONS: These results indicate that DFS of about 70% can be expected in MRD-negative patients after induction therapy, and the patients did not benefit from HSCT in 1CR. This study was registered with the UMIN Clinical Trials Registry (UMIN-CTR), number UMIN000001519.
OBJECTIVE: We investigated whether minimal residual disease (MRD) status in adult patients with Philadelphia chromosome (Ph)-negative acute lymphoblastic leukemia (ALL) is useful for decision on clinical indications for allogeneic hematopoietic stem cell transplantation (HSCT). METHODS: We prospectively monitored MRD after induction and consolidation therapy in adult patients with Ph-negative ALL. RESULTS: Among 103 adult ALL patients enrolled, 59 were Ph-negative, and MRD status was assessed in 51 patients. The probability of 3-year overall survival (OS) and disease-free survival (DFS) was 69% (95%CI 54-80) and 50% (95%CI 36-63), respectively. Patients who were MRD-negative after induction therapy (n = 15) had a significantly better 3-year DFS compared with those who were MRD-positive (n = 30; 73% vs 41%, P = 0.018). Patients who were MRD-positive after induction but became MRD-negative after consolidation chemotherapy C in the first course (n = 11) showed a significantly worse 3-year DFS compared with patients who were MRD-negative after induction chemotherapy A in the first course (45% vs 73%, P = 0.025). CONCLUSIONS: These results indicate that DFS of about 70% can be expected in MRD-negative patients after induction therapy, and the patients did not benefit from HSCT in 1CR. This study was registered with the UMIN Clinical Trials Registry (UMIN-CTR), number UMIN000001519.