Pre-emptive immunotherapy for clearance of molecular disease in childhood acute lymphoblastic leukemia after transplantation

  • Monitoring of minimal residual disease (MRD) or chimerism may help guide pre-emptive immunotherapy (IT) with a view to preventing relapse in childhood acute lymphoblastic leukemia (ALL) after transplantation. Patients with ALL who consecutively underwent transplantation in Frankfurt/Main, Germany between January 1, 2005 and July 1, 2014 were included in this retrospective study. Chimerism monitoring was performed in all, and MRD assessment was performed in 58 of 89 patients. IT was guided in 19 of 24 patients with mixed chimerism (MC) and MRD and by MRD only in another 4 patients with complete chimerism (CC). The 3-year probabilities of event-free survival (EFS) were .69 ± .06 for the cohort without IT and .69 ± .10 for IT patients. Incidences of relapse (CIR) and treatment-related mortality (CITRM) were equally distributed between both cohorts (without IT: 3-year CIR, .21 ± .05, 3-year CITRM, .10 ± .04; IT patients: 3-year CIR, .18 ± .09, 3-year CITRM .13 ± .07). Accordingly, 3-year EFS and 3-year CIR were similar in CC and MC patients with IT, whereas MC patients without IT experienced relapse. IT was neither associated with an enhanced immune recovery nor an increased risk for acute graft-versus-host disease. Relapse prevention by IT in patients at risk may lead to the same favorable outcome as found in CC and MRD-negative-patients. This underlines the importance of excellent MRD and chimerism monitoring after transplantation as the basis for IT to improve survival in childhood ALL.

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Author:Eva Rettinger, Michael Merker, Emilia Salzmann-Manrique, Hermann KreyenbergORCiDGND, Thomas Krenn, Matthias Dürken, Jörg Faber, Sabine Hünecke, Claudia Cappel, Melanie Bremm, Andre Manfred WillaschORCiDGND, Shahrzad Bakhtiar, Andrea Jarisch, Jan Sörensen, Thomas KlingebielORCiDGND, Peter BaderORCiDGND
Pubmed Id:
Parent Title (English):Biology of blood and marrow transplantation
Publisher:Elsevier Health Sciences
Place of publication:[s. l.]
Document Type:Article
Year of Completion:2016
Date of first Publication:2016/10/11
Publishing Institution:Universitätsbibliothek Johann Christian Senckenberg
Release Date:2018/02/15
Tag:Allogeneic hematopoietic stem; Chimerism; Minimal residual disease; Pre-emptive immunotherapy; cell transplantation
Page Number:9
First Page:87
Last Page:95
Under a Creative Commons license
Institutes:Medizin / Medizin
Dewey Decimal Classification:6 Technik, Medizin, angewandte Wissenschaften / 61 Medizin und Gesundheit / 610 Medizin und Gesundheit
Licence (German):License LogoCreative Commons - Namensnennung-Nicht kommerziell - Keine Bearbeitung 4.0