In:
British Journal of Haematology, Wiley, Vol. 169, No. 2 ( 2015-04), p. 249-261
Kurzfassung:
Relapse after transplantation is a major cause of treatment failure in paediatric acute lymphoblastic leukaemia ( ALL ). Here, we report the findings of a prospective national study designed to investigate the feasibility of immune intervention in children in first or subsequent remission following myeloablative conditioning. This study included 133 children who received a transplant for ALL between 2005 and 2008. Minimal Residual Disease ( MRD ) based on T cell receptor/immunoglobulin gene rearrangements was measured on days −30, 30, 90 and 150 post‐transplantation. Ciclosporin treatment was rapidly discontinued and donor lymphocyte infusions ( DLI ) were programmed for patients with a pre‐ or post‐transplant MRD status ≥10 −3 . Only nine patients received DLI . Pre‐ and post‐transplant MRD status, and the duration of ciclosporin were independently associated with 5‐year overall survival ( OS ), which was 62·07% for the whole cohort. OS was substantially higher in patients cleared of MRD than in those with persistent MRD (52·3% vs. 14·3%, respectively). Only pre‐transplant MRD status (Hazard Ratio 2·57, P = 0·04) and duration of ciclosporin treatment ( P 〈 0·001) were independently associated with relapse. The kinetics of chimerism were not useful for predicting relapse, whereas MRD monitoring up to 90 d post‐transplantation was a valuable prognostic tool to guide therapeutic intervention.
Materialart:
Online-Ressource
ISSN:
0007-1048
,
1365-2141
DOI:
10.1111/bjh.2015.169.issue-2
Sprache:
Englisch
Verlag:
Wiley
Publikationsdatum:
2015
ZDB Id:
1475751-5