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ctt-journal > Popov et al. (Abstract)

Popov et al. (Abstract)

Cellular Therapy and Transplantation (CTT), Vol. 3, No. 9
doi: 10.3205/ctt-2010-No9-abstract42
© The Authors. This abstract is provided under the following license: Creative Commons Attribution 3.0 Unported

Abstract accepted for "4th Raisa Gorbacheva Memorial Meeting on Hematopoietic Stem Cell Transplantation",
Saint Petersburg, Russia, September 18–20, 2010

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Early blast reduction parameters predict the minimal residual disease status (MRD) at the end of ALL-MB 2008 protocol remission induction

Alexander M. Popov1,2,3, Grigory A. Tsaur1,2, Tatiana Yu. Verzhbitskaya1,2, Olga V. Streneva1,2, Olga P. Khlebnikova1, Alexander G. Solodovnikov2,3, Egor V. Shorikov1,2, Leonid I. Saveliev1,2,3, Larisa G. Fechina1,2

1Regional Children’s Hospital No. 1, Ekaterinburg, Russia; 2Research Institute of Medical Cell Technologies, Ekaterinburg, Russia; 3Ural State Medical Academy, Ekaterinburg, Russia

Correspondence: Alexander M. Popov, Regional Children Hospital No. 1, Pediatric Oncology / Hematology Center, 32, S. Deryabina str., 620149, Ekaterinburg, Russia, E-mail: uralflow@spam is badgmail.com

Abstract

We evaluated 54 children with ALL. Their MRD status on day 15 (MRDd15) and day 36 (MRDd36) was assessed by 6-9-color flow cytometry. End-induction (day 36) MRD results were categorized as “positive” or “negative”. The predictive impact of initial risk factors on the MRDd36 status was analyzed. The absolute peripheral blood blast count on day 8 (BCPBd8), the bone marrow blast percentage on day 15 (BMBPd15), and the MRDd15 were investigated in addition to the initial parameters. These variables were categorized according to threshold levels (TL) defined by ROC-curve analysis. The parameters’ significance was tested in a multiple logistic regression model. Odds ratios (OR) with 95% confidential intervals (CI), sensitivity, specificity, positive and negative predictive values (PPV & NPV), and overall correct prediction (OCP) were calculated.

Among the initial parameters, the difference between MRDd36-positive and MRDd36-negative patients was observed only for age. Hence age was added to the response parameters for further investigation. TLs were defined as 0.160% for MRDd15, 0.5% for BPBMd15, 3 years for age, and 38 blasts/μl for BCPBd8. The MRDd36-positivity probability was significantly higher in patients who had MRDd15, BPBMd15, age, and BCPBd8 levels higher than the TL. The diagnostic performance tests are shown below. MRDd15 and age remained significantly contributing variables (p=0.003 and p=0.04 correspondingly) to the regression model with OCP rate of 77.36%. Thus, in our series among all analyzed parameters, a high MRD level on day 15 is the strongest single predictor of MRDd36-positivity.

The MRD status in childhood ALL after remission induction of ALL-MB-2008 protocol could be predicted by early blast reduction parameters and age, while the MRD level on day 15 is the strongest single predictor.

OR

95% CI

p

Sensitivity (%)

Specificity (%)

PPV (%)

NPV (%)

OCP (%)

Univariate analysis

MRDd15

29.08

3.46–244.47

0.002

95.45

58.06

61.76

94.74

73.59

BPBMd15

6.33

1.56–25.71

0.010

86.36

50.00

54.29

84.21

64.81

Age

4.97

1.47–16.86

0.010

77.27

59.38

56.67

79.17

66.67

BCPBd8

5.16

1.56–17.02

0.007

59.09

78.13

65.00

73.53

70.37

Multivariate analysis

MRDd15

25.53

2.90–224.50

0.003

-

-

-

-

-

Age

4.43

1.07–18.34

0.040

-

-

-

-

-

Regression model

11.11

3.12–39.65

0.0001

72.73

80.65

72.73

80.65

77.36


Keywords: minimal residual disease, flow cytometry, ALL

 

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