Medline ® Abstract for Reference 24
of 'Overview of the treatment of acute lymphoblastic leukemia in children and adolescents'
Treatment of high-risk Philadelphia chromosome-negative acute lymphoblastic leukemia in adolescents and adults according to early cytologic response and minimal residual disease after consolidation assessed by flow cytometry: final results of the PETHEMA ALL-AR-03 trial.
Ribera JM, Oriol A, Morgades M, Montesinos P, SarràJ, González-Campos J, Brunet S, Tormo M, Fernández-Abellán P, Guàrdia R, Bernal MT, Esteve J, Barba P, Moreno MJ, Bermúdez A, Cladera A, Escoda L, García-Boyero R, Del Potro E, Bergua J, Amigo ML, Grande C, Rabuñal MJ, Hernández-Rivas JM, Feliu E
J Clin Oncol. 2014;32(15):1595.
PURPOSE: Minimal residual disease (MRD) is an important prognostic factor in adults with acute lymphoblastic leukemia (ALL) and may be used for treatment decisions. The Programa Español de Tratamientos en Hematología (PETHEMA) ALL-AR-03 trial (Treatment of High Risk Adult Acute Lymphoblastic Leukemia [LAL-AR/2003]) assigned adolescent and adult patients (age 15 to 60 years) with high-risk ALL (HR-ALL) without the Philadelphia (Ph) chromosome to chemotherapy or to allogeneic hematopoietic stem-cell transplantation (allo-HSCT) according to early cytologic response (day 14) and flow-MRD level after consolidation.
PATIENTS AND METHODS: Patients with good early cytologic response (<10% blasts in bone marrow at day 14 of induction) and a flow-MRD level less than 5×10(-4) at the end of consolidation were assigned to delayed consolidation and maintenance therapy, and allo-HSCT was scheduled in patients with poor early cytologic response or flow-MRD level≥5×10(-4).
RESULTS: Complete remission was attained in 282 (87%) of 326 patients, and 179 (76%) of 236 patients who completed early consolidation were assigned by intention-to treat to receive allo-HSCT (71) or chemotherapy (108). Five-year disease-free survival (DFS) and overall survival (OS) probabilities were 37% and 35% for the whole series, 32% and 37% for patients assigned to allo-HSCT, and 55% and 59% for those assigned to chemotherapy. Multivariable analysis showed poor MRD clearance (≥1×10(-3) after induction and≥5×10(-4) after early consolidation) as the only prognostic factor for DFS and OS.
CONCLUSION: Prognosis for Ph-negative HR-ALL in adolescents and adults with good early response to induction and low flow-MRD levels after consolidation is quite favorable when allo-HSCT is avoided. In this study, the pattern of MRD clearance was the only prognostic factor for DFS and OS.
Josep-Maria Ribera, Albert Oriol, Mireia Morgades, and Evarist Feliu, Institut Catalàd'Oncologia-Hospital Germans Trias i Pujol-Jose Carreras Research Institute; Salut Brunet, Hospital de Sant Pau; Jordi Esteve, Hospital Clínic; Pere Barba, Hospital Vall d'Hebron, Barcelona; Pau Montesinos, Hospital Universitario La Fe; Mar Tormo, Hospital Clínico, Valencia; Josep Sarrà, Institut Catalàd'Oncologia-Hospital Duran i Reynals, L'Hospitalet de Llobregat; JoséGonzález-Campos, Hospital Universitario Virgen del Rocío, Sevilla; Pascual Fernández-Abellán, Hospital General, Alicante; Ramon Guàrdia, Institut Catalàd'Oncologia-Hospital Josep Trueta, Girona; María-Teresa Bernal, Hospital Central de Asturias, Oviedo; María-JoséMoreno, Hospital Virgen de la Victoria, Málaga; Arancha Bermúdez, Hospital Marqués de Valdecilla, Santander; Antonia Cladera, Hospital Son Llàtzer, Palma de Mallorca; Lourdes Escoda, Hospital Joan XXIII, Tarragona; Raimundo García-Boyero, Hospital General, Castellón; Eloy del Potro, Hospital Clínico San Carlos; Carlos Grande, Hospital Doce de Octubre, Madrid; Juan Bergua, Hospital San Pedro de Alcántara, Cáceres; María-Luz Amigo, Hospital Morales Meseguer, Murcia; María-JoséRabuñal, Hospital Xeral, Santiago de Compostela; and Jesús-María Hernández-Rivas, Hospital Universitario-Instituto del Cáncer, Universidad de Salamanca, Salamanca, Spain. firstname.lastname@example.org.