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Minimal residual disease (MRD) enables reliable assessment of risk in acute lymphoblastic leukemia (ALL). However, little is known on association between MRD status and germline genetic variation. We examined 159 Caucasian (Slavic) patients with pediatric ALL, treated according to ALL-IC-BFM 2002/2009 protocols, in search for association between 23 germline polymorphisms and MRD status at day 15, day 33 and week 12, with adjustment for MRD-associated clinical covariates. Three variants were significantly associated with MRD: rs1544410 in  VDR  (MRD-day15); rs1051266 in  RFC  (MRD-day33, MRD-week12), independently and in an additive effect with rs10519613 in  IL15  (MRD-day33). The risk alleles for MRD-positivity were: A allele of  VDR  (OR = 2.37, 95%CI = 1.07–5.21,  P  = 0.03, MRD-day15); A of  RFC  (OR = 1.93, 95%CI = 1.05–3.52,  P  = 0.03, MRD-day33 and MRD-week12,  P  < 0.01); A of  IL15  (OR = 2.30, 95%CI = 1.02–5.18,  P  = 0.04, MRD-day33). The risk for MRD-day33-positive status was higher in patients with risk alleles in both  RFC  and  IL15  loci than in patients with risk alleles in one locus or no risk alleles: 2 vs. 1 (OR = 3.94, 95% CI = 1.28–12.11,  P  = 0.024), 2 vs. 0 (OR = 6.75, 95% CI = 1.61–28.39,  P  = 0.012). Germline variation in genes related to pharmacokinetics/pharmacodynamics of anti-leukemic drugs and to anti-tumor immunity of the host is associated with MRD status and might help improve risk assessment in ALL.

Association of germline genetic variants in RFC, IL15 and VDR genes with minimal residual disease in pediatric B-cell precursor ALL