Risk factors for positive post-transplantation measurable residual disease in patients with acute lymphoblastic leukemia.
10.1097/CM9.0000000000003150
- Author:
Yuewen WANG
1
;
Guomei FU
2
;
Lanping XU
1
;
Yu WANG
1
;
Yifei CHENG
1
;
Yuanyuan ZHANG
1
;
Xiaohui ZHANG
1
;
Yanrong LIU
1
;
Kaiyan LIU
1
;
Xiaojun HUANG
1
;
Yingjun CHANG
1
Author Information
1. Department of Hematology, Peking University People's Hospital, Peking University Institute of Hematology, Beijing 100044, China.
2. Department of Hematology, Peking University People's Hospital and National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing 100044, China.
- Publication Type:Journal Article
- Keywords:
Acute lymphoblastic leukemia;
Allogeneic hematopoietic stem cell transplantation;
Measurable residual disease;
Posttransplantation;
Relapse;
Risk factors
- MeSH:
Humans;
Precursor Cell Lymphoblastic Leukemia-Lymphoma/pathology*;
Neoplasm, Residual;
Hematopoietic Stem Cell Transplantation/methods*;
Male;
Female;
Risk Factors;
Adolescent;
Adult;
Child;
Child, Preschool;
Young Adult;
Middle Aged;
Infant;
Transplantation, Homologous;
Proportional Hazards Models;
Retrospective Studies
- From:
Chinese Medical Journal
2025;138(9):1084-1093
- CountryChina
- Language:English
-
Abstract:
BACKGROUND:The level of measurable residual disease (MRD) before and after transplantation is related to inferior transplant outcomes, and post-hematopoietic stem cell transplantation measurable residual disease (post-HSCT MRD) has higher prognostic value in determining risk than pre-hematopoietic stem cell transplantation measurable residual disease (pre-HSCT MRD). However, only a few work has been devoted to the risk factors for positive post-HSCT MRD in patients with acute lymphoblastic leukemia (ALL). This study evaluated the risk factors for post-HSCT MRD positivity in patients with ALL who underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT).
METHODS:A total of 1683 ALL patients from Peking University People's Hospital between January 2009 and December 2019 were enrolled to evaluate the cumulative incidence of post-HSCT MRD. Cox proportional hazard regression models were built for time-to-event outcomes. Multivariable analysis was performed to determine independent influencing factors from the univariable analysis.
RESULTS:Both in total patients and in T-cell ALL or B-cell ALL, pediatric or adult, human leukocyte antigen-matched sibling donor transplantation or haploidentical SCT subgroups, positive pre-HSCT MRD was a risk factor for post-HSCT MRD positivity ( P <0.001 for all). Disease status (complete remission 1 [CR1] vs . ≥CR2) was also a risk factor for post-HSCT MRD positivity in all patients and in the B cell-ALL, pediatric, or haploidentical SCT subgroups ( P = 0.027; P = 0.003; P = 0.035; P = 0.003, respectively). A risk score for post-HSCT MRD positivity was developed using the variables pre-HSCT MRD and disease status. The cumulative incidence of post-HSCT MRD positivity was 12.3%, 25.1%, and 38.8% for subjects with scores of 0, 1, and 2-3, respectively ( P <0.001). Multivariable analysis confirmed the association of the risk score with the cumulative incidence of post-HSCT MRD positivity and relapse as well as leukemia-free survival and overall survival.
CONCLUSION:Our results indicated that positive pre-MRD and disease status were two independent risk factors for post-HSCT MRD positivity in patients with ALL who underwent allo-HSCT.
