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Risk of relapse of childhood acute lymphoblastic leukemia is predicted by flow cytometric measurement of residual disease on day 15 bone marrow
Journal of Clinical Oncology, 10/08/09

Basso G et al. – Measurement of FCM MRD in day 15 bone marrow was the most powerful early predictor of relapse, applicable to virtually all patients; it may complement PCR MRD–based stratification including later time points, thus allowing additional treatment tailoring.

Methods

Bone marrow samples from 830 Italian patients collected on day 15, after 14 days of steroids, and one dose of intrathecal methotrexate, vincristine, daunorubicine, and asparaginase
Cells analyzed by four-color FCM for detection of leukemia-associated immunophenotypes

Results

3 patient risk groups were identified by FCM: standard (< 0.1% blast cells; 42% of the total), intermediate (0.1 to < 10%; 47%), and high ( 10%; 11%)
5-year cumulative incidences of relapse were 7.5% (SE, 1.5), 17.5% (SE, 2.1), and 47.2% (SE, 5.9)
In multivariate analysis, FCM was most important prognostic factor among those available by day 15, with two-fold and five-fold increase in risk of relapse compared with patients with less than 0.1%
PCR MRD, when added to the model, had significant prognostic impact; yet high levels of FCM MRD retained an independent ability to detect a significantly higher risk of relapse

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