Department of Pediatric Hematology, Dokuz Eylül University Medical Faculty, İzmir.
Department of Pediatric Hematology, Uludağ University Medical Faculty, Bursa.
J Pediatr Hematol Oncol. 2022 Mar 1;44(2):e396-e402. doi: 10.1097/MPH.0000000000002419.
Assestment of minimal residual disease (MRD) in childhood acute lymphoblastic leukemia (ALL) is of utmost importance both for risk classification and tailoring of the therapy. The data of pediatric ALL patients that received treatment with Berlin-Frankfurt-Münster (BFM) protocols were retrospectively collected from 5 university hospitals in Turkey. Of the 1388 patients enrolled in the study 390 were treated according to MRD-based protocols. MRD assestment was with real time quantitative polymerase chain reaction (qPCR) in 283 patients and with multiparametric flow cytometry (MFC)-MRD in 107 patients. MRD monitoring had upstaged a total of 8 patients (2%) from intermediate risk group to high-risk group. Univariate analysis revealed age 10 years or above, prednisone poor response, PCR-MRD ≥10-3 on day 33 and on day 78 as poor prognostic factors affecting event-free survival (EFS). Detection of >10% blasts on day 15 with MFC (MFC-high-risk group) was not shown to affect EFS and/or overall survival (log-rank P=0.339). Multiple logistic regression analysis revealed PCR-MRD ≥10-3 on day 78 as the only poor prognostic factor affecting EFS (odds ratio: 8.03; 95% confidence interval: 2.5-25; P=0.000). It is very important to establish the infrastructure and ensure necessary standardization for both MRD methods for optimal management of children with ALL.
儿童急性淋巴细胞白血病（ALL）微小残留病（MRD）的评估对于风险分类和治疗方案的调整都非常重要。本研究回顾性收集了来自土耳其 5 所大学医院接受柏林-法兰克福-慕尼黑（BFM）方案治疗的儿科 ALL 患者的数据。在纳入研究的 1388 例患者中，390 例根据基于 MRD 的方案进行治疗。283 例患者采用实时定量聚合酶链反应（qPCR）进行 MRD 评估，107 例患者采用多参数流式细胞术（MFC）-MRD 进行评估。MRD 监测共将 8 例（2%）中危组患者升级为高危组。单因素分析显示，年龄≥10 岁、泼尼松反应不良、第 33 天和第 78 天 PCR-MRD≥10-3是影响无事件生存（EFS）的不良预后因素。MFC 检测第 15 天>10%blasts（MFC-高危组）未显示影响 EFS 和/或总生存（对数秩 P=0.339）。多因素逻辑回归分析显示，第 78 天 PCR-MRD≥10-3 是影响 EFS 的唯一不良预后因素（比值比：8.03；95%置信区间：2.5-25；P=0.000）。为了优化 ALL 患儿的管理，建立 MRD 两种方法的基础设施并确保必要的标准化非常重要。
