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Description and prognostic significance of the kinetics of minimal residual disease status in adults with acute lymphoblastic leukemia treated with HyperCVAD
Author(s) -
Cassaday Ryan D.,
Stevenson Philip A.,
Wood Brent L.,
Becker Pamela S.,
Hendrie Paul C.,
Sandmaier Brenda M.,
Radich Jerald L.,
Shustov Andrei R.
Publication year - 2018
Publication title -
american journal of hematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.456
H-Index - 105
eISSN - 1096-8652
pISSN - 0361-8609
DOI - 10.1002/ajh.25030
Subject(s) - medicine , minimal residual disease , hazard ratio , oncology , multivariate analysis , lymphoblastic leukemia , confidence interval , leukemia
Abstract HyperCVAD is a commonly‐used regimen for adults with newly‐diagnosed acute lymphoblastic leukemia (ALL). However, relatively little is known about the application of minimal residual disease (MRD) detection with this treatment. To address this, we studied 142 adults with ALL treated with hyperCVAD over a 10‐year period who had MRD assessed by either multi‐parameter flow cytometry or (for patients with Philadelphia chromosome positive ALL) reverse transcriptase polymerase chain reaction for the BCR‐ABL1 translocation. In a multivariate analysis, patients who achieved MRD negativity (MRD Neg ) at any point had significantly better overall survival (OS; hazard ratio [HR] 0.43; P = .01) and event‐free survival (EFS; HR 0.27; P < .01). Of 121 patients with MRD assessed at various points within 90 days of starting hyperCVAD, 50% ( n = 61) had achieved MRD Neg . Among those that became MRD Neg , the median time to MRD Neg was 68 days. Time to MRD Neg was significantly associated with EFS ( P = .009), but not OS ( P = .19), implying increasingly better EFS the earlier MRD Neg is achieved. These data add to our understanding of MRD assessment during treatment with hyperCVAD, aide clinicians with predicting relapse risk, and provide additional historical data on which future clinical trials can be designed.