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Blood, 1 December 2007, Vol. 110, No. 12, pp. 4022-4029. Prepublished online as a Blood First Edition Paper on August 24, 2007; DOI 10.1182/blood-2007-04-082040. This Article Full Text Full Text (PDF) Supplemental Appendix All Versions of this Article: blood-2007-04-082040v1 110/12/4022    most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Rights and Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Hagedorn, N. Articles by Eckert, C. Search for Related Content PubMed PubMed Citation Articles by Hagedorn, N. Articles by Eckert, C. Related Collections Neoplasia Clinical Trials and Observations Social Bookmarking                   What's this?  Previous Article  |  Table of Contents  |  Next Article  NEOPLASIA Submicroscopic bone marrow involvement in isolated extramedullary relapses in childhood acute lymphoblastic leukemia: a more precise definition of "isolated" and its possible clinical implications, a collaborative study of the Resistant Disease Committee of the International BFM study group Nikola Hagedorn1, Cécile Acquaviva2, Eva Fronkova3, Arend von Stackelberg1, Andrea Barth1, Udo zur Stadt4, André Schrauder5, Jan Trka3, Nathalie Gaspar6, Karl Seeger1, Günter Henze1, Hélène Cavé2, and Cornelia Eckert1 1 Department of Pediatric Oncology/Hematology, Charité Medical University Berlin, Berlin, Germany; 2 Laboratoire de Biochimie Génétique–Département de Génétique, Hôpital Robert Debré, Paris, France; 3 Department of Pediatric Hematology/Oncology, 2nd Medical School, Charles University, Prague, Czech Republic; 4 Department of Pediatric Hematology/Oncology, University Medical Center Hamburg, Eppendorf, Germany; 5 Department of Pediatrics, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany; and 6 Service d'Hématol-immunologie pédiatrique, Hôpital Robert Debré, Paris, France This study investigates the extent of bone marrow (BM) involvement at diagnosis of apparent isolated extramedullary (AIEM) relapses of childhood acute lymphoblastic leukemia (ALL) and its relation to prognosis. Sixty-four children with first AIEM relapse treated in Germany, Czech Republic, or France were included. Real-time quantitative polymerase chain reaction using T-cell receptor and immunoglobulin gene rearrangements provided a sensitive measure of submicroscopic BM involvement, which was detectable at a level of 10–4 or higher in 46 patients and less than 10–4 in 11 patients, and was nondetectable (sensitivity: 10–4) in 7 patients. In the total cohort, the probability of event-free survival (pEFS) for children with BM involvement of 10–4 or higher was 0.30 (0.09 ± SE) versus 0.60 (± 0.12) for those with less than 10–4 (P = .13). The cumulative incidence of subsequent relapse was 0.24 (± 0.01) for patients with BM involvement less than 10–4 and 0.65 (± 0.01) for those with 10–4 or higher (P = .012). Restricted to central nervous system (CNS) relapses, pEFS was 0.11 (± 0.09) for patients with BM involvement 10–4 or higher and 0.63 (± 0.17) for those with less than 10–4 (P = .053). CNS relapses were associated with a higher ( 10–4: 80%) submicroscopic BM involvement than testicular relapses ( 10–4: 57%, P = .08). In summary, we show marked heterogeneity of submicroscopic BM involvement at first AIEM relapse diagnosis in children with ALL, and demonstrate its possible prognostic relevance. CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this? This article has been cited by other articles: C.-H. Pui, D. Campana, D. Pei, W. P. Bowman, J. T. Sandlund, S. C. Kaste, R. C. Ribeiro, J. E. Rubnitz, S. C. Raimondi, M. Onciu, et al. Treating Childhood Acute Lymphoblastic Leukemia without Cranial Irradiation N. Engl. J. Med., June 25, 2009; 360(26): 2730 - 2741. [Abstract] [Full Text] [PDF]

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