The largest multicenter prospective study of MRD in infant acute lymphoblastic leukemia (ALL) has found that MRD is of significant prognostic value for infants with KMT2A-rearranged ALL. The study by an international team of researchers appeared in the Journal of Clinical Oncology in February.
KMT2A rearrangement occurs in 75% of infants (under 1 year of age) diagnosed with ALL and is associated with poor outcomes, the authors write. This study involved 439 infants with KMT2A-rearranged ALL in 12 countries who were enrolled in the Interfant-06 protocol, were in a first complete remission following induction therapy, and were randomly assigned to either lymphoid-style or myeloid-style consolidation chemotherapy.
Among 249 patients for whom MRD data were available, those with high MRD at the end of induction (EOI) therapy had better outcomes when treated with myeloid-like consolidation therapy, whereas patients with low MRD did better when treated with lymphoid-type consolidation therapy. Outcomes were dismal for patients with positive MRD at the end of consolidation.
“Our data indicate that ALL-based induction leads to selection of patients who respond well to lymphoid-type treatment (those with low EOI MRD) and are likely to benefit from lymphoid-style consolidation therapy,” the authors write. “On the other hand, poor response to the ALL-based induction (high EOI MRD) suggests more myeloid-like leukemia that should be offered a myeloid-style consolidation therapy.”
- Stutterheim J, van der Sluis IM, de Lorenzo P, et al. Clinical Implications of Minimal Residual Disease Detection in Infants With KMT2A-Rearranged Acute Lymphoblastic Leukemia Treated on the Interfant-06 Protocol. J Clin Oncol. 2021;39(6):652-662. doi:10.1200/JCO.20.02333