Measurable residual disease in children with acute lymphoblastic
leukemia treated with non-MRD based protocol, what we are missing,
experience from tertiary care centre in central India
Abstract
Age, presenting total leukocyte counts, steroid response and
cytogenetics are known prognostic markers for acute lymphoblastic
leukemia (ALL). Measurable Residual Disease (MRD) (or minimal residual
disease) after induction chemotherapy is well accepted prognostic
markers in childhood leukemia. In resource constrained countries
evaluation of MRD either not widely available or increases the cost of
treatment. We retrospectively analyzed data of patients, treated with
non-MRD based protocol, to see correlation of known risk factors and
risk groups with end of induction MRD. Children with acute lymphoblastic
leukemia treated with IC-BFM 2002 (Non-MRD based protocol) and end of
the induction MRD was done. Day15 bone marrow morphology and risk groups
were significantly associated with MRD level. All standard risk patients
except one had MRD negative. Significant number of intermediate risk
group and high risk group had positive MRD. In resource constrained
settings, MRD can be avoided in standard risk, but cannot be avoided in
higher risk group for optimization of therapy.