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Original Article
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Volume 339:591-598 August 27, 1998 Number 9
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Clinical Significance of Minimal Residual Disease in Childhood Acute Lymphoblastic Leukemia
Hélène Cavé Cave, Ph.D., Jutte van der Werff ten Bosch, M.D., Stefan Suciu, M.S., Christine Guidal, M.S., Christine Waterkeyn, M.S., Jacques Otten, M.D., Marleen Bakkus, Ph.D., Kris Thielemans, M.D., Bernard Grandchamp, Ph.D., M.D., Etienne Vilmer, M.D., Brigitte Nelken, Martine Fournier, Patrick Boutard, Emmanuel Lebrun, Françoise Méchinaud, Richard Garand, Alain Robert, Nicole Dastugue, Emmanuel Plouvier, Evelyne Racadot, Alice Ferster, Jan Gyselinck, Odile Fenneteau, Michel Duval, Gabriel Solbu, Anne-Marie Manel, for The European Organization for Research and Treatment of Cancer–Childhood Leukemia Cooperative Group

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ABSTRACT

Background and Methods The implications of the detection of residual disease after treatment of acute lymphoblastic leukemia (ALL) are unclear. We conducted a prospective study at 11 centers to determine the predictive value of the presence or absence of detectable residual disease at several points in time during the first six months after complete remission of childhood ALL had been induced. Junctional sequences of T-cell–receptor or immunoglobulin gene rearrangements were used as clonal markers of leukemic cells. Residual disease was quantitated with a competitive polymerase-chain-reaction (PCR) assay. Of 246 patients enrolled at diagnosis and treated with a uniform chemotherapy protocol, 178 were monitored for residual disease with one clone-specific probe (in 74 percent) or more than one probe (in 26 percent). The median follow-up period was 38 months.

Results The presence or absence and level of residual leukemia were significantly correlated with the risk of early relapse at each of the times studied (P<0.001). PCR measurements identified patients at high risk for relapse after the completion of induction therapy (those with >=10–2 residual blasts per 2x105 mononuclear bone marrow cells) or at later time points (those with >=10–3 residual blasts). Multivariate analysis showed that as compared with immunophenotype, age, risk group (standard or very high risk), and white-cell count at diagnosis, the presence or absence and level of residual disease were the most powerful independent prognostic factors.

Conclusions Residual leukemia after induction of a remission is a powerful prognostic factor in childhood ALL. Detection of residual disease by PCR should be used to identify patients at risk for relapse and should be taken into account in considering alternative treatment.


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From the Laboratoire de Biochimie Génétique and the Service d'Hémato-Immunologie, Hôpital Robert Debré, Paris (H.C., C.G., B.G., E.V.); the Department of Physiology, Vrige Universiteit Brussel, Brussels, Belgium (J.W.B., M.B., K.T.); the European Organization for Research and Treatment of Cancer Data Center, Brussels, Belgium (S.S., C.W.); and the Akademisch Ziekenhuis, Vrige Universiteit Brussel, Brussels, Belgium (J.O.). Other authors were Brigitte Nelken and Martine Fournier (Centre Hospitalier Universitaire, Lille, France), Patrick Boutard and Emmanuel Lebrun (Centre Hospitalier Universitaire, Caen, France), Françoise Méchinaud and Richard Garand (Centre Hospitalier Régional Hôtel Dieu, Nantes, France), Alain Robert and Nicole Dastugue (Centre Hospitalier Universitaire, Toulouse, France), Emmanuel Plouvier and Evelyne Racadot (Centre Hospitalier Régional, Besançon, France), Alice Ferster (Centre Hospitalier Universitaire, Reine Fabiola, Brussels, Belgium), Jan Gyselinck (Algemeen Kinderziekenhuis, Antwerp, Belgium), Odile Fenneteau and Michel Duval (Hôpital Robert Debré, Paris), Gabriel Solbu (European Organization for Research and Treatment of Cancer Data Center, Brussels, Belgium), and Anne-Marie Manel (Centre Hospitalier Régional, Lyons, France).The views expressed in this article are solely those of the authors and do not represent the official views of the National Cancer Institute.

Address reprint requests to Dr. Vilmer at the Service d'Hémato-Immunologie, Hôpital Robert Debré, 48 Blvd. Serurier, 75019 Paris, France.

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Related Letters:

Detection of Residual Disease in Childhood Acute Lymphoblastic Leukemia
Faderl S., Estrov Z., Machida U., Kami M., Hirai H., Cavé H., Suciu S., Vilmer E.
Extract | Full Text  
N Engl J Med 1999; 340:152-154, Jan 14, 1999. Correspondence

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