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Blood, 15 June 2008, Vol. 111, No. 12, pp. 5477-5485. Prepublished online as a Blood First Edition Paper on April 3, 2008; DOI 10.1182/blood-2008-01-132837. This Article Full Text Full Text (PDF) Supplemental Tables All Versions of this Article: blood-2008-01-132837v1 111/12/5477    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 CrossRef Google Scholar Articles by Borowitz, M. J. Articles by Camitta, B. M. PubMed PubMed Citation Articles by Borowitz, M. J. Articles by Camitta, B. M. Related Collections Neoplasia Clinical Trials and Observations Social Bookmarking                   What's this?  Previous Article  |  Table of Contents  |  Next Article  CLINICAL TRIALS AND OBSERVATIONS Clinical significance of minimal residual disease in childhood acute lymphoblastic leukemia and its relationship to other prognostic factors: a Children's Oncology Group study Michael J. Borowitz1, Meenakshi Devidas2, Stephen P. Hunger3, W. Paul Bowman4, Andrew J. Carroll5, William L. Carroll6, Stephen Linda2, Paul L. Martin7, D. Jeanette Pullen8, David Viswanatha9, Cheryl L. Willman10, Naomi Winick11, Bruce M. Camitta12, for the Children's Oncology Group13 1 Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD; 2 Children's Oncology Group and the College of Medicine, University of Florida, Gainesville; 3 University of Colorado Denver and The Children's Hospital, Aurora; 4 Cook Children's Hospital, Fort Worth, TX; 5 University of Alabama at Birmingham; 6 New York University School of Medicine, New York, NY; 7 Duke University School of Medicine, Durham, NC; 8 University of Mississippi School of Medicine, Jackson; 9 Mayo Clinic, Rochester, MN; 10 University of New Mexico School of Medicine, Albuquerque; 11 University of Texas Southwestern School of Medicine, Dallas; 12 Midwest Children's Cancer Center, Medical College of Wisconsin, Milwaukee; and 13 Children's Oncology Group, Arcadia, CA Minimal residual disease (MRD) is an important predictor of relapse in acute lymphoblastic leukemia (ALL), but its relationship to other prognostic variables has not been fully assessed. The Children's Oncology Group studied the prognostic impact of MRD measured by flow cytometry in the peripheral blood at day 8, and in end-induction (day 29) and end-consolidation marrows in 2143 children with precursor B-cell ALL (B-ALL). The presence of MRD in day-8 blood and day-29 marrow MRD was associated with shorter event-free survival (EFS) in all risk groups; even patients with 0.01% to 0.1% day-29 MRD had poor outcome compared with patients negative for MRD patients (59% ± 5% vs 88% ± 1% 5-year EFS). Presence of good prognostic markers TEL-AML1 or trisomies of chromosomes 4 and 10 still provided additional prognostic information, but not in National Cancer Insitute high-risk (NCI HR) patients who were MRD+. The few patients with detectable MRD at end of consolidation fared especially poorly, with only a 43% plus or minus 7% 5-year EFS. Day-29 marrow MRD was the most important prognostic variable in multi-variate analysis. The 12% of patients with all favorable risk factors, including NCI risk group, genetics, and absence of days 8 and 29 MRD, had a 97% plus or minus 1% 5-year EFS with nonintensive therapy. These studies are registered at www.clinicaltrials.gov as NCT00005585 [ClinicalTrials.gov] , NCT00005596 [ClinicalTrials.gov] , and NCT00005603 [ClinicalTrials.gov] . CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

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