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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 (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 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. Social Bookmarking                   What's this?  Previous Article  |  Next Article  Submitted November 4, 2008 Accepted December 30, 2008 Improved risk classification for risk-specific therapy based on the molecular study of MRD in adult ALL Renato Bassan*, Orietta Spinelli, Elena Oldani, Tamara Intermesoli, Manuela Tosi, Barbara Peruta, Giuseppe Rossi, Erika Borlenghi, Enrico M. Pogliani, Elisabetta Terruzzi, Pietro Fabris, Vincenzo Cassibba, Giorgio Lambertenghi-Deliliers, Agostino Cortelezzi, Alberto Bosi, Giacomo Gianfaldoni, Fabio Ciceri, Massimo Bernardi, Andrea Gallamini, Daniele Mattei, Eros Di Bona, Claudio Romani, Anna Maria Scattolin, Tiziano Barbui, and Alessandro Rambaldi U.S.C. Ematologia, Ospedali Riuniti, Bergamo, Italy Divisione di Ematologia, Spedali Civili, Brescia, Italy Clinica Ematologica, Ospedale "San Gerardo", Universita Milano Bicocca, Monza, Italy Divisione Ematologia, Azienda Sanitaria dell'Alto Adige, Bolzano, Italy U.O. Ematologia I, IRCSS Ospedale Maggiore Policlinico, Universita degli Studi, Milano, Italy S.C. Ematologia, A.O. Universitaria "Careggi", Firenze, Italy U.O. Ematologia, Fondazione Centro "S. Raffaele del Monte Tabor", Milano, Italy S.C. Ematologia, A.S.O. "Santa Croce e Carle", Cuneo, Italy U.O. Ematologia, A.O. ULSS-6, Vicenza, Italy U.O. Ematologia, Ospedale Oncologico "A. Businco", Cagliari, Italy U.O. Ematologia, Ospedale dell'Angelo, Venezia-Mestre, Italy * Corresponding author; email: rbassan{at}ospedaliriuniti.bergamo.it. Clinical risk classification is somewhat 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 post-consolidation maintenance (in MRDneg) or SCT (in MRDpos). MRD was tested at weeks 10, 16, and 22 using RQ-PCR with 1 sensitive probes. Only patients with t(9;22) or t(4;11) were immediately eligible to 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 to 0.33/0.14 in MRDpos (P = .0000), regardless of the clinical risk class. MRD was the most significant risk factor for relapse (hazard ratio 5.22). MRD results at weeks 16-22 correlated strongly with the earlier time point (P = .000) using a level 10-4 to define persistent disease. MRD analysis during early postremission therapy improves risk definitions and bolster risk-oriented strategies. (ClinicalTrials.gov Identifier: NCT00358072) CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

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