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ORIGINAL ARTICLE
Year : 2020  |  Volume : 3  |  Issue : 2  |  Page : 183-191

Outcomes and impact of minimal residual disease (MRD) in pediatric, adolescent and young adults (AYA) with acute lymphoblastic leukemia treated with modified MCP 841 protocol


1 Department of Medical Oncology, State Cancer Institute, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
2 Consultant Hemato-Pathologist, Oncquest Laboratories, New Delhi, India

Correspondence Address:
Avinash Pandey
Room Number 83, 84, Department of Medical Oncology, State Cancer Institute, Indira Gandhi Institute of Medical Sciences, Patna, Bihar
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/CRST.CRST_85_20

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Background: The impact of minimal residual disease (MRD) on overall survival (OS) is insufficiently studied in pediatric, adolescent, and young adults (AYA) with acute lymphoblastic leukemia (ALL) treated with modified MCP 841 protocol. Objectives: We planned to evaluate the outcomes (post-induction response rates, MRD, and OS) with modified MCP 841 in pediatric and AYA ALL. Materials and Methods: This was a retrospective audit of patients with ALL registered between March 01, 2017, and August 31, 2019. Patients who received at least 7 days of therapy on modified MCP 841 protocol were analyzed. Response evaluation was done on day 35 of induction with bone marrow aspiration, and MRD was assessed with flow cytometry with <0.01% as a “cutoff” for MRD-negative status. The primary endpoint was OS defined from start of therapy till death from any cause after day 35 of induction. Survival was evaluated by the Kaplan–Meier method, and log-rank test was used to compare the impact of variables on outcome in Statistical Package for the Social Sciences version 17.0. Results: 130/167 (78%) patients were started on MCP 841 protocol; the remaining 37 (22%) patients defaulted after the first visit. B-cell ALL was more common at 78 (60%). 94 (72%) had National Cancer Institute High Risk. Day 8 good prednisolone response (GPR) was seen in 76 (58%) patients. Morphological remission was noted in 90/107 (84%) patients. MRD status was available in 84 (78%) patients. 46 (43%) patients achieved MRD-negative status. The median follow-up was 21 months (range, 10–31 months). The median OS was 30 months (95% CI, 15.5–42.8 months). One-year and 2-year survival was 87% and 60%, respectively. Patients who were MRD negative did better than those with MRD positive, 29 versus 22 months (P = 0.03). GPR performed better than those with Poor Prednisolone Response (PPR), 29 versus 15 months (P = 0.01). Conclusion: Post-induction MRD is a useful prognostic tool for ALL patients treated with modified MCP 841 protocol. Outcomes are suboptimal compared to those reported from the developed western world.


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