autologous blood and marrow transplantation - Blog Science ...

Hoelzer and Gôkbuget
treatment option for those with high MRD levels. The course of MRD during the
first year of treatment is another independent risk factor. A review of 14 studies
from the literature showed that 48% of the patients with MRD after induction
therapy relapse compared with 12% of MRD-negative patients. At the end of
therapy, 61% of MRD-positive patients relapsed compared with 15% of MRD-
negative patients. Thus, patients with reportedly positive or increasing MRD levels
carry a high risk of relapse, whereas patients with decreasing and finally low levels
have a more favorable outcome. Two recently published trials in pediatric ALL
patients demonstrated that MRD detection at any time point of therapy is signifi­
cantly correlated with relapse risk. 26
' 27
An individualized treatment strategy could be based on sequential MRD
evaluations during the first year of treatment, and BMT could be scheduled for
those who are still MRD-positive after 1 year. For autoBMT, MRD evaluation
offers the possibility to evaluate the leukemic blast proportion in the graft and
assess remission control after transplantation. This approach may provide
reasonable indications for the intensity and duration of post-BMT maintenance
treatment.
Thus, two major alternatives for MRD-adapted BMT indications are available:
• the indication for early BMT according to the quantitative MRD status after
induction treatment; and
• the indication for delayed BMT according to the course of MRD during the first
year of treatment.
Both approaches may lead to an individualized treatment strategy, with
treatment intensity adapted to the relapse risk of the individual. Additional
candidates for BMT in CR1 will be identified and, most importantly, in patients
with repeatedly negative MRD status, treatment could be stopped after 1 year.
REFERENCES
1. Hoelzer D: The role of bone marrow transplantation in the management of Ph-positive
acute lymphoblastic leukemia in adults. In Dicke KA, Keating A (eds) Autologous Marrow
and Blood Transplantation: Proceedings of the Eighth Symposium, Arlington, Texas.
Charlottesville, VA: Carden Jennings, 1997, p. 79.
2. Frassoni F, Labopin M, Gluckman E, et al.: Results of allogeneic bone marrow trans­
plantation for acute leukemia have improved in Europe with time: A report of the Acute
Leukemia Working Party of the European Group for Blood and Marrow Transplantation
(EBMT). Bone Marrow Transplant 17:13, 1996.
3. Appelbaum FR: Graft versus leukemia (GVL) in the therapy of acute lymphoblastic
leukemia (ALL). Leukemia 11:15, 1997.
4. Horowitz MM, Gale RP, Sondel PM, et al.: Graft-versus-leukemia reactions after bone
marrow transplantation. Blood 75:555, 1990.
5. Cahn J-Y, Labopin M, Schattenberg A, Reiffers J, Willemze R, Zittoun R, Bacigalupo
69