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Modvig S, Madsen HO, Siitonen SM, Rosthøj S, Tierens A, Juvonen V, Osnes LTN, Vålerhaugen H, Hultdin M, Thörn I, Matuzeviciene R, Stoskus M, Marincevic M, Fogelstrand L, Lilleorg A, Toft N, Jónsson OG, Pruunsild K, Vaitkeviciene G, Vettenranta K, Lund B, Abrahamsson J, Schmiegelow K, Marquart HV. Minimal residual disease quantification by flow cytometry provides reliable risk stratification in T-cell acute lymphoblastic leukemia. Leukemia 2019; 33:1324-1336. [PMID: 30552401 DOI: 10.1038/s41375-018-0307-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 10/26/2018] [Accepted: 10/31/2018] [Indexed: 01/22/2023]
Abstract
Minimal residual disease (MRD) measured by PCR of clonal IgH/TCR rearrangements predicts relapse in T-cell acute lymphoblastic leukemia (T-ALL) and serves as risk stratification tool. Since 10% of patients have no suitable PCR-marker, we evaluated flowcytometry (FCM)-based MRD for risk stratification. We included 274 T-ALL patients treated in the NOPHO-ALL2008 protocol. MRD was measured by six-color FCM and real-time quantitative PCR. Day 29 PCR-MRD (cut-off 10-3) was used for risk stratification. At diagnosis, 93% had an FCM-marker for MRD monitoring, 84% a PCR-marker, and 99.3% (272/274) had a marker when combining the two. Adjusted for age and WBC, the hazard ratio for relapse was 3.55 (95% CI 1.4-9.0, p = 0.008) for day 29 FCM-MRD ≥ 10-3 and 5.6 (95% CI 2.0-16, p = 0.001) for PCR-MRD ≥ 10-3 compared with MRD < 10-3. Patients stratified to intermediate-risk therapy on day 29 with MRD 10-4-<10-3 had a 5-year event-free survival similar to intermediate-risk patients with MRD < 10-4 or undetectable, regardless of method for monitoring. Patients with day 15 FCM-MRD < 10-4 had a cumulative incidence of relapse of 2.3% (95% CI 0-6.8, n = 59). Thus, FCM-MRD allows early identification of patients eligible for reduced intensity therapy, but this needs further studies. In conclusion, FCM-MRD provides reliable risk prediction for T-ALL and can be used for stratification when no PCR-marker is available.
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Affiliation(s)
- S Modvig
- Department of Clinical Immunology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - H O Madsen
- Department of Clinical Immunology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - S M Siitonen
- Helsinki University Ctrl. Hospital, Helsinki, Finland
| | - S Rosthøj
- Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - A Tierens
- Laboratory Medicine Program, University Health Network and University of Toronto, Toronto, ON, Canada
- Department of Pathology, University Hospital of Oslo, Oslo, Norway
| | - V Juvonen
- Department of Clinical Chemistry and Laboratory Division, University of Turku and Turku University Hospital, Turku, Finland
| | - L T N Osnes
- Department of Immunology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - H Vålerhaugen
- Department of Pathology, Laboratory of Molecular Pathology, Oslo University Hospital, Oslo, Norway
| | - M Hultdin
- Department of Medical Biosciences, Pathology, Umeå University, Umeå, Sweden
| | - I Thörn
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - R Matuzeviciene
- Department of Physiology, Biochemistry, Microbiology and Laboratory Medicine, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Centre of Laboratory Medicine, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - M Stoskus
- Hematology, Oncology and Transfusion Medicine Centre, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - M Marincevic
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - L Fogelstrand
- Department of Clinical Chemistry, Sahlgrenska University Hospital, and Department of Clinical Chemistry and Transfusion Medicine, Institute of Biomedicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - A Lilleorg
- Department of Clinical Immunology, North Estonia Medical Centre, Tallinn, Estonia
| | - N Toft
- Department of Hematology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - O G Jónsson
- Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland
| | - K Pruunsild
- Tallinn Children's Hospital, Tallinn, Estonia
| | - G Vaitkeviciene
- Children's Hospital, Affiliate of Vilnius University Hospital Santariskiu Klinikos, Vilnius, Lithuania
| | - K Vettenranta
- Department of Pediatrics, Helsinki University Children's Hospital and University of Helsinki, Helsinki, Finland
| | - B Lund
- Department of Pediatrics, St. Olavs University Hospital and Department of Clinical and Molecular Medicine, NTNU, Trondheim, Norway
| | - J Abrahamsson
- Institution of Clinical Sciences, Department of Pediatrics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - K Schmiegelow
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- The Institute of Clinical medicine, The Faculty of Medicine, University of Copenhagen, Copenhagen, Denmark
| | - H V Marquart
- Department of Clinical Immunology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
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Blystad AK, Delabie J, Kvaløy S, Holte H, Vålerhaugen H, Ikonomou I, Kvalheim G. Infused CD34+
cell dose, but not tumour cell content of peripheral blood progenitor cell grafts, predicts clinical outcome in patients with diffuse large B-cell lymphoma and follicular lymphoma grade 3 treated with high-dose therapy. Br J Haematol 2004; 125:605-12. [PMID: 15147376 DOI: 10.1111/j.1365-2141.2004.04951.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Previously, we have shown that patients with diffuse large B-cell lymphoma (DLBCL) transplanted with contaminated bone marrow (BM) generally have a poor outcome. Whether this is also the case when peripheral blood progenitor cell (PBPC) grafts are used is not known. Forty-three patients with chemosensitive DLBCL or follicular lymphoma grade 3 (FLgr3) were treated with high-dose therapy (HDT) and autologous stem cell support. Nine patients received purged grafts. Quantitative real-time polymerase chain reaction (QRT-PCR) for either the BCL2/IgH translocation or allele specific oligonucleotide (ASO) QRT-PCR for the immunoglobulin heavy chain (IgH) complementarity-determining region 3 were used. Nine of 25 (36%) PBPC grafts contained tumour cells as tested by QRT-PCR, including two grafts purged by CD34(+) cell enrichment combined with B-cell depletion. The level of contamination of the PBPC/CD34(+) cells ranged from 0 to 8.28%. No relationship could be shown between the total number of tumour cells infused and relapse. Patients receiving PCR-positive or PCR-negative PBPC grafts had similar progression-free survival (PFS) (P = 0.49). However, a significant difference was seen in PFS and overall survival (OS) for the patients given >/=6.1 x 10(6) CD34(+) cells/kg compared with those given <6.1 x 10(6) CD34(+) cells/kg (P = 0.01 and P < 0.05 respectively).
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Affiliation(s)
- A K Blystad
- Department of Oncology, The Norwegian Radium Hospital, Oslo, Norway.
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