British journal of haematology, 2017-04, Vol.177 (1), p.116-126
In children with acute myeloid leukaemia (AML), assessment of initial treatment response is an essential prognostic factor; methods more sensitive than morphology are still under evaluation. We report on the measurement of minimal residual disease (MRD), by multicolour flow‐cytometry in one centralized laboratory, in 142 children with newly diagnosed AML enrolled in the Associazione Italiana di EmatoOncologia Pediatrica‐AML 2002/01 trial. At the end of the first induction course, MRD was 〈0·1% in 69, 0·1–1% in 16 and 〉1% in 51 patients. The 8‐year disease‐free survival (DFS) of 125 children in morphological complete remission and with MRD 〈0·1%, 0·1–1% and ≥1% was 73·1 ± 5·6%, 37·8 ± 12·1% and 34·1 ± 8·8%, respectively (P 〈 0·01). MRD was also available after the second induction course in 92/142 patients. MRD was ≥0·1% at the end of the first induction course in 36 patients; 13 reached an MRD 〈0·1% after the second one and their DFS was 45·4 ± 16·7% vs. 22·8 ± 8·9% in patients with persisting MRD ≥0·1% (P = 0·037). Multivariate analysis demonstrated that MRD ≥0·1% after first induction course was, together with a monosomal karyotype, an independent adverse prognostic factor for DFS. Our results show that MRD detected by flow‐cytometry after induction therapy predicts outcome in patients with childhood AML and can help stratifying post‐remission treatment.
Minimal residual disease ; Acute myeloid leukaemia ; Paediatric; Risk group ; Flow‐cytometry ; Multivariate Analysis ; Prognosis ; Follow-Up Studies ; Humans ; Child, Preschool ; Immunophenotyping ; Infant ; Male ; Treatment Outcome ; Leukemia, Myeloid, Acute - mortality ; Flow Cytometry ; Leukemia, Myeloid, Acute - diagnosis ; Antineoplastic Combined Chemotherapy Protocols - therapeutic use ; Neoplasm, Residual - diagnosis ; Adolescent ; Survival Analysis ; Leukemia, Myeloid, Acute - drug therapy ; Female ; Child ; Infant, Newborn ; Medical research ; Analysis ; Medicine, Experimental ; Transplantation ; Children ; Chromosomes ; Hematopoietic stem cells ; Diseases ; Index Medicus
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