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Residual leukaemia after bone marrow transplant in children with acute lymphoblastic leukaemia after first haematological relapse or with poor initial presenting features
Author(s) -
Bunin Nancy,
Johnston Dennis A.,
Roberts W. Mark,
Ouspenskaia Maia V.,
Papusha Victor Z.,
Brandt Mark A.,
Zipf Theodore F.
Publication year - 2003
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1046/j.1365-2141.2003.04135.x
Subject(s) - medicine , minimal residual disease , bone marrow , acute lymphocytic leukemia , transplantation , regimen , conditioning regimen , gastroenterology , immunology , leukemia , surgery , hematopoietic stem cell transplantation , lymphoblastic leukemia
Summary. Relapse is the major obstacle to cure for children with acute lymphoblastic leukaemia (ALL) after allogeneic bone marrow transplant (BMT). Development of salvage therapy for post‐transplant relapse could be expedited by understanding the post‐transplant behaviour of microscopically undetectable leukaemia and the ability to predict impending relapse. We have used a quantitative polymerase chain reaction method (sensitivity of 5·0 × 10 −6 ) to measure residual leukaemia before the conditioning regimen, and at five time‐points after transplantation. In total, 18 patients with ALL transplanted in first or second remission were studied for 1 year: For the first year post BMT, 12 remained in remission, four had haematological relapses, one had a cutaneous relapse, and one died of severe graft‐versus‐host disease. The post‐engraftment levels of the leukaemia‐specific immunoglobulin heavy (IgH) chain gene rearrangement for patients with haematological relapses were significantly different from those who remained in remission. The levels for the patients who remained in remission decreased with time, although there were occasional increases consistent with the known standard deviation of the measurement assay. In contrast, all clinical relapses were preceded by a rapid increase in levels. Both the rate of this increase and its timing were variable. These results suggest that residual leukaemia measurements can be used to direct post‐transplant interventions and measure their effects.