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Prepublished online as a Blood First Edition Paper on May 31, 2002; DOI 10.1182/blood-2002-04-1130.
Submitted April 15, 2002
Accepted May 16, 2002
USE OF PERIPHERAL BLOOD INSTEAD OF BONE MARROW TO MONITOR RESIDUAL DISEASE IN CHILDREN WITH ACUTE LYMPHOBLASTIC LEUKEMIA
Elaine Coustan-Smith, Jose Sancho, Michael L Hancock, Bassem I Razzouk, Raul C Ribeiro, Gaston K Rivera, Jeffrey E Rubnitz, John T Sandlund, Ching-Hon Pui, and Dario Campana*
Department of Hematology-Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
Department of Hematology-Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA; Department of Pediatrics, University of Tennessee, Memphis, TN, USA
Department of Hematology-Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA; Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, USA; Department of Pediatrics, University of Tennessee, Memphis, TN, USA
* Corresponding author; email: dario.campana{at}stjude.org.
In children with acute lymphoblastic leukemia (ALL), response to treatment is assessed by bone marrow aspiration. We investigated whether minimal residual disease (MRD) can be effectively monitored in peripheral blood. We used flow cytometric techniques capable of detecting 1 leukemic cell among 10,000 or more normal cells to compare MRD measurements in 718 pairs of bone marrow and peripheral blood samples collected from 226 children during treatment for newly diagnosed ALL. MRD was detected in both marrow and blood in 72 pairs and in marrow but not in blood in 67 pairs; it was undetectable in the remaining 579 pairs. Remarkably, findings in marrow and blood were completely concordant in the 150 paired samples from patients with T-lineage ALL: for each of the 35 positive marrow samples, the corresponding blood sample was positive. In B-lineage ALL, however, only 37 of the 104 positive marrow samples had a corresponding positive blood sample. Notably, peripheral-blood MRD in these patients was associated with a very high risk of disease recurrence. The 4-year cumulative incidence of relapse in patients with B-lineage ALL was 80.0% ± 24.9% for those who had peripheral-blood MRD at the end of remission induction therapy but only 13.3% ± 9.1% for those with MRD confined to the marrow (P = 0.007). These results indicate that peripheral blood could be used to monitor MRD in patients with T-lineage ALL, and that peripheral-blood MRD may provide strong prognostic information in patients with B-lineage ALL.
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