Predictive Value of Dynamic Peri-Transplantation MRD Assessed By MFC Either Alone or in Combination with Other Variables for Outcomes of Patients with T-Cell Acute Lymphoblastic Leukemia

Abstract

SummaryWe performed a retrospective analysis to investigate dynamic peri-hematopoietic stem cell transplantation (HSCT) minimal/measurable residual disease (MRD) on outcomes in patients with T-cell acute lymphoblastic leukemia (T-ALL). A total of 271 patients were enrolled and classified into three groups: unchanged negative MRD pre- and post-HSCT group (group A), post-MRD non-increase group (group B), and post-MRD increase group (group C). The patients in group B and group C experienced a higher cumulative incidence of relapse (CIR) (42% vs. 71% vs. 16%, P<0.001) and lower leukemia-free survival (LFS) (46% vs. 21% vs. 70%, P<0.001) and overall survival (OS) (50% vs. 28% vs. 72%, P<0.001) than in group A, but there was no significant difference in non-relapse mortality (NRM) among three groups (14% vs. 12% vs. 8%, P=0.752). Multivariate analysis showed that dynamic peri-HSCT MRD was associated with CIR (HR=2.392, 95% CI, 1.816–3.151, P<0.001), LFS (HR=1.964, 95% CI, 1.546–2.496, P<0.001) and OS (HR=1.731, 95% CI, 1.348–2.222, P<0.001). We also established a risk scoring system based on dynamic peri-HSCT MRD combined with remission status pre-HSCT and onset of chronic graft-verses-host disease (GVHD). This risk scoring system could better distinguish CIR (c=0.730) than that for pre-HSCT MRD (c=0.562), post-HSCT MRD (c=0.616) and pre- and post-MRD dynamics (c=0.648). Our results confirm the outcome predictive value of dynamic peri-HSCT MRD either alone or in combination with other variables for patients with T-ALL.

Unmanipulated haploidentical hematopoietic stem cell transplantation for mixed phenotype acute leukemia: a single center study

“…However, these HSCT reports mostly focused on MSD/MUD HSCT, with only a few mentioning haplo-HSCT without detailed information. Our center recently reported a 3-year OS of 64% and LFS of 62% in patients with T-ALL (traditionally considered an ALL subtype with a poor prognosis), as well as a 4-year OS of 76% and LFS of 73% in patients with AML [30,31]. Both EFS and OS were slightly higher in this study than they were for ALL and AML patients, due to a lower incidence of relapse in the MPAL group, as well as the fact that no patients died from TRM events.…”

Allogeneic haematopoietic stem cell transplantation for adult T‐lymphoblastic lymphoma: A real‐world multicentre analysis in China

“…An OS event was defined as death as a result of any cause. Leukaemia‐associated aberrant immunophenotypes (LAIPs) and/or different from normal (DfN) were identified by multiparameter flow cytometry (MFC), and 0.01% was applied as a threshold to distinguish MRD positivity (Supplementary Method) 34,35 …”

Immunophenotypic measurable residual disease monitoring in adult acute lymphoblastic leukemia patients undergoing allogeneic hematopoietic stem cell transplantation

“…Interestingly, recent evidences support the usefulness of dynamic peri-transplant (i.e., serial pre and post allo-HSCT) MFC MRD monitoring. For instance, a retrospective study on 271 T-ALL adult and pediatric patients has recently shown that dynamic peritransplant MFC MRD monitoring could be better in discriminating the risk of relapse than single time point pre or post allo-HSCT assessments (61). Similarly, in a pediatric series of 166 ALL patients undergoing haploidentical unmanipulated transplant and dynamic peri-transplant MFC MRD assessments, increasing MRD levels were associated to lower LFS and OS, and higher CIR (62).…”

“…Overall, regardless technical differences and the relatively low series number, the studies summarized in Table 1 indicate that in adult ALL patients undergoing allo-HSCT MFC can be a reliable MRD assessment technique. Moreover, studies in adult and pediatric patients indicate that MFC may have an increasing predictivity depending on MRD positivity levels (47,49,60) and/or peritransplant trend (61,62). Unfortunately, no data are available regarding the predictive impact of post over pre allo-HSCT MFC MRD monitoring.…”