Prognostic significance of ETP phenotype and minimal residual disease in T-ALL: a Children’s Oncology Group study

医学 微小残留病 内科学 免疫分型 胃肠病学 淋巴细胞白血病 白血病 免疫学 流式细胞术
作者
Brent L. Wood,Meenakshi Devidas,Ryan J. Summers,Zhiguo Chen,Barbara L. Asselin,Karen R. Rabin,Patrick A. Zweidler‐McKay,Naomi J. Winick,Michael J. Borowitz,William L. Carroll,Elizabeth A. Raetz,Mignon L. Loh,Stephen P. Hunger,Kimberly P. Dunsmore,David T. Teachey,Stuart S. Winter
出处
期刊:Blood [American Society of Hematology]
卷期号:142 (24): 2069-2078 被引量:21
标识
DOI:10.1182/blood.2023020678
摘要

Abstract The early thymic precursor (ETP) immunophenotype was previously reported to confer poor outcome in T-cell acute lymphoblastic leukemia (T-ALL). Between 2009 and 2014, 1256 newly diagnosed children and young adults enrolled in Children’s Oncology Group (COG) AALL0434 were assessed for ETP status and minimal residual disease (MRD) using flow cytometry at a central reference laboratory. The subject phenotypes were categorized as ETP (n = 145; 11.5%), near-ETP (n = 209; 16.7%), or non-ETP (n = 902; 71.8%). Despite higher rates of induction failure for ETP (6.2%) and near-ETP (6.2%) than non-ETP (1.2%; P < .0001), all 3 groups showed excellent 5-year event-free survival (EFS) and overall survival (OS): ETP (80.4% ± 3.9% and 86.8 ± 3.4%, respectively), near-ETP (81.1% ± 3.3% and 89.6% ± 2.6%, respectively), and non-ETP (85.3% ± 1.4% and 90.0% ± 1.2%, respectively; P = .1679 and P = .3297, respectively). There was no difference in EFS or OS for subjects with a day-29 MRD <0.01% vs 0.01% to 0.1%. However, day-29 MRD ≥0.1% was associated with inferior EFS and OS for patients with near-ETP and non-ETP, but not for those with ETP. For subjects with day-29 MRD ≥1%, end-consolidation MRD ≥0.01% was a striking predictor of inferior EFS (80.9% ± 4.1% vs 52.4% ± 8.1%, respectively; P = .0001). When considered as a single variable, subjects with all 3 T-ALL phenotypes had similar outcomes and subjects with persistent postinduction disease had inferior outcomes, regardless of their ETP phenotype. This clinical trial was registered at AALL0434 as #NCT00408005.
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