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Blood, 30 April 2009, Vol. 113, No. 18, pp. 4153-4162. Prepublished online as a Blood First Edition Paper on January 13, 2009; DOI 10.1182/blood-2008-11-185132. This Article Full Text Full Text (PDF) Supplemental Figures All Versions of this Article: blood-2008-11-185132v1 113/18/4153    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 Citing Articles via Google Scholar Google Scholar Articles by Bassan, R. Articles by Rambaldi, A. Search for Related Content PubMed PubMed Citation Articles by Bassan, R. Articles by Rambaldi, A. Related Collections Free Research Articles Lymphoid Neoplasia Clinical Trials and Observations Social Bookmarking                   What's this?  Previous Article  |  Table of Contents  |  Next Article  CLINICAL TRIALS AND OBSERVATIONS Improved risk classification for risk-specific therapy based on the molecular study of minimal residual disease (MRD) in adult acute lymphoblastic leukemia (ALL) Renato Bassan1, Orietta Spinelli1, Elena Oldani1, Tamara Intermesoli1, Manuela Tosi1, Barbara Peruta1, Giuseppe Rossi2, Erika Borlenghi2, Enrico M. Pogliani3, Elisabetta Terruzzi3, Pietro Fabris4, Vincenzo Cassibba4, Giorgio Lambertenghi-Deliliers5, Agostino Cortelezzi5, Alberto Bosi6, Giacomo Gianfaldoni6, Fabio Ciceri7, Massimo Bernardi7, Andrea Gallamini8, Daniele Mattei8, Eros Di Bona9, Claudio Romani10, Anna Maria Scattolin11, Tiziano Barbui1, and Alessandro Rambaldi1 1 Unità Strutturale Complessa di Ematologia, Ospedali Riuniti, Bergamo; 2 Divisione di Ematologia, Spedali Civili, Brescia; 3 Clinica Ematologica, Ospedale San Gerardo, Università Milano Bicocca, Monza; 4 Divisione di Ematologia, Azienda Sanitaria dell'Alto Adige, Bolzano; 5 Unità Operativa di Ematologia I, IRCCS Ospedale Maggiore Policlinico, Università degli Studi, Milano; 6 Struttura Complessa di Ematologia, Azienda Ospedaliera Universitaria Careggi, Firenze; 7 Unità Operativa di Ematologia, Fondazione Centro S Raffaele del Monte Tabor, Milano; 8 Struttura Complessa di Ematologia, Azienda Sanitaria Ospedaliera Santa Croce e Carle, Cuneo; 9 Unità Operativa di Ematologia, Azienda Ospedaliera ULSS-6, Vicenza; 10 Unità Operativa di Ematologia, Ospedale Oncologico A Businco, Cagliari; and 11 Unità Operativa di Ematologia, Ospedale dell'Angelo, Venezia-Mestre, Italy Clinical risk classification is inaccurate in predicting relapse in adult patients with acute lymphoblastic leukemia, sometimes resulting in patients receiving inappropriate chemotherapy or stem cell transplantation (SCT). We studied minimal residual disease (MRD) as a predictive factor for recurrence and as a decisional tool for postconsolidation maintenance (in MRDneg) or SCT (in MRDpos). MRD was tested at weeks 10, 16, and 22 using real-time quantitative polymerase chain reaction with 1 or more sensitive probes. Only patients with t(9;22) or t(4;11) were immediately eligible for allogeneic SCT. Of 280 registered patients (236 in remission), 34 underwent an early SCT, 60 suffered from relapse or severe toxicity, and 142 were evaluable for MRD at the end of consolidation. Of these, 58 were MRDneg, 54 MRDpos, and 30 were not assessable. Five-year overall survival/disease-free survival rates were 0.75/0.72 in the MRDneg group compared with 0.33/0.14 in MRDpos (P = .001), regardless of the clinical risk class. MRD was the most significant risk factor for relapse (hazard ratio, 5.22). MRD results at weeks 16 to 22 correlated strongly with the earlier time point (P = .001) using a level of 10–4 or higher to define persistent disease. MRD analysis during early postremission therapy improves risk definitions and bolsters risk-oriented strategies. ClinicalTrials.gov identifier: NCT00358072 [ClinicalTrials.gov] . CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

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