Impact of measurable residual disease on outcomes using a modified DFCI protocol for adults with BCR-ABL negative acute lymphoblastic leukemia.
AI interpretation is pending for this paper.
Open original publication →What the AI sees
Not AI summarized yet.
Research significance
Pending deeper interpretation.
Source abstract
Adults with acute lymphoblastic leukemia (ALL) have been reported to have favorable outcomes with the pediatric-based DFCI protocol, but measurable residual disease (MRD) data were lacking. We retrospectively evaluated outcomes in all adults with ALL treated with the DFCI protocol, including a modified protocol for patients >age 60, over a 10-year period (n = 89) in a real-world setting. MRD was assessed post-induction using multiparameter flow cytometry (MPFS) with 0.01% sensitivity. The morphologic complete remission (CR) rate was 92% treated with DFCI vs. 65% with DFCI > 60 (p = 0.0015), due to a higher induction mortality due to sepsis in patients >age 60. The 5-year overall survival (OS) was 72% and disease-free survival (DFS) of the CR patients was 66%. The OS was inferior in patients who received DFCI > 60 vs. DFCI but the DFS was not different. The OS declined with increasing age group (18-35 vs. 36-60 vs. >60, p = 0.011). Patients who were MRD negative (<0.01%) post-induction had a 5-year DFS of 80% vs. 47% for those with MRD > 0.1% (p = 0.01); the 5-year OS was 90% for MRD negative patients vs. 62% for MRD > 0.1% (p = 0.039). The 5-year DFS outcomes by MRD were comparable in the B-ALL patients (77% vs. 48%, p = 0.047). In patients aged > 35 years, MRD > 0.1% also predicted for inferior DFS (78% vs. 34%, p = 0.036) but not in patients aged 18-35. For MRD+ patients there was no difference in DFS comparing patients transplanted in CR1 vs. non-transplanted patients. On multivariate analysis MRD post-induction remained a significant predictor of DFS (p = 0.007), while age group was not significant. In conclusion, MRD is a significant predictor of outcomes with DFCI. DFS and OS are high in MRD negative patients, without the use of blinatumomab.