Measurable residual disease (MRD) should be considered a treatment-informing prognostic marker among patients with B-cell acute lymphocytic leukemia (B-ALL), according to research published in Haematologica.
Previous research has suggested that MRD is a good prognostic indicator of whether patients with B-ALL are likely to have disease recurrence after reaching complete disease remission, though evidence on this subject is conflicting. Given that more than a third of patients with B-ALL experience a recurrence, there is a significant need for a treatment-informing prognostic marker.
For this systematic literature review and analysis, researchers obtained data from 23 studies published or presented at a conference between 2005 and 2017; the number of patients included in each study ranged from 27 to 1648. All but 2 included studies used data from patients during their first remission.
The researchers found a hazard ratio (HR) of 2.34 for relapse-free survival among patients who reached MRD across all included studies, as well as an HR of 2.19 for overall survival.
However, the studies that were given greater weight in the primary analysis tended to exhibit weaker HRs for relapse-free survival; the study with the highest weight, which included a patient population of 432, had an HR of 1.69.
The researchers also noted that subgroup analyses of disease stage, MRD sensitivity threshold level, Philadelphia chromosome status, histologic phenotype, risk group, MRD testing location, MRD timing after induction, and MRD detection did not affect the results.
They concluded that their results suggest MRD can be used as a prognostic marker to inform the management of patients with B-ALL.
1. Bassan R, Brüggemann M, Radcliffe H-S, Hartfield E, Kreuzbauer G, Wetten S. A systematic literature review and meta-analysis of minimal residual disease as a prognostic indicator in adult B-cell acute lymphoblastic leukemia. Haematologica. 2019;104:2028-2039.