Prognostic significance of MRD and its correlation with arsenic concentration in pediatric acute promyelocytic leukemia: a retrospective study by SCCLG-APL group
Background: Treatment outcomes for acute promyelocytic leukemia (APL) have improved with all-trans-retinoic acid and arsenic trioxide, yet relapse remains a concern, especially in pediatric patients. The prognostic value of minimal residual disease (MRD) post-induction and the impact of arsenic leve...
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SAGE Publishing
2025-01-01
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| Series: | Therapeutic Advances in Hematology |
| Online Access: | https://doi.org/10.1177/20406207241311774 |
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| author | Zhong Fan Liang-Chun Yang Yi-Qiao Chen Wu-Qing Wan Dun-Hua Zhou Hui-Rong Mai Wan-Li Li Li-Hua Yang He-Kui Lan Hui-Qin Chen Bi-Yun Guo Zi-Jun Zhen Ri-Yang Liu Guo-Hua Chen Xiao-Qin Feng Cong Liang Li-Na Wang Yu-Li Jie-Si Luo Dan-Ping Huang Xue-Qun Luo Bin Li Li-Bin Huang Xiao-Li Zhang Yan-Lai Tang |
| author_facet | Zhong Fan Liang-Chun Yang Yi-Qiao Chen Wu-Qing Wan Dun-Hua Zhou Hui-Rong Mai Wan-Li Li Li-Hua Yang He-Kui Lan Hui-Qin Chen Bi-Yun Guo Zi-Jun Zhen Ri-Yang Liu Guo-Hua Chen Xiao-Qin Feng Cong Liang Li-Na Wang Yu-Li Jie-Si Luo Dan-Ping Huang Xue-Qun Luo Bin Li Li-Bin Huang Xiao-Li Zhang Yan-Lai Tang |
| author_sort | Zhong Fan |
| collection | DOAJ |
| description | Background: Treatment outcomes for acute promyelocytic leukemia (APL) have improved with all-trans-retinoic acid and arsenic trioxide, yet relapse remains a concern, especially in pediatric patients. The prognostic value of minimal residual disease (MRD) post-induction and the impact of arsenic levels during induction on MRD are not fully understood. Objectives: To evaluate the relationship between post-induction MRD levels and relapse-free survival (RFS) in pediatric APL patients, and to investigate the correlation between blood arsenic concentration levels during induction therapy and MRD status. Design: A retrospective analysis of pediatric APL patients enrolled in a clinical trial from September 2011 to July 2020. Methods: We assessed the relationship between RFS and post-induction MRD levels using the log-rank test. The optimal MRD cut-off was determined using the “surv_cutpoint” function in the survminer R package. Arsenic concentration levels were monitored in 16 patients on days 7 and 14 of induction therapy, and Spearman correlation was used to analyze the relationship between arsenic concentrations and MRD levels. Results: Among 176 pediatric APL patients, with a median follow-up of 6 years, 4 relapsed. Patients with MRD >3.1% had significantly lower RFS compared to those with MRD ⩽3.1% (94.6% vs 100%, p = 0.023). In addition, a negative correlation was found between blood arsenic concentration levels and post-induction MRD levels. Lower arsenic concentrations were associated with higher MRD levels, with significant correlations observed for trough concentrations ( R = −0.666, p = 0.005) and peak concentrations ( R = −0.499, p = 0.049) on day 7. Conclusion: Our study highlights the prognostic significance of post-induction MRD assessment in pediatric APL. We also demonstrate a negative correlation between blood arsenic concentration levels and MRD, suggesting that lower arsenic concentrations during induction therapy may contribute to a higher MRD burden. These findings may inform strategies to optimize treatment and improve outcomes in pediatric APL. Trial registration: www.clinicaltrials.gov (NCT02200978). |
| format | Article |
| id | doaj-art-641f5a0a7eb843c3963d3353b9e80e46 |
| institution | Kabale University |
| issn | 2040-6215 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Therapeutic Advances in Hematology |
| spelling | doaj-art-641f5a0a7eb843c3963d3353b9e80e462025-01-07T14:03:20ZengSAGE PublishingTherapeutic Advances in Hematology2040-62152025-01-011610.1177/20406207241311774Prognostic significance of MRD and its correlation with arsenic concentration in pediatric acute promyelocytic leukemia: a retrospective study by SCCLG-APL groupZhong FanLiang-Chun YangYi-Qiao ChenWu-Qing WanDun-Hua ZhouHui-Rong MaiWan-Li LiLi-Hua YangHe-Kui LanHui-Qin ChenBi-Yun GuoZi-Jun ZhenRi-Yang LiuGuo-Hua ChenXiao-Qin FengCong LiangLi-Na Wang Yu-LiJie-Si LuoDan-Ping HuangXue-Qun LuoBin LiLi-Bin HuangXiao-Li ZhangYan-Lai TangBackground: Treatment outcomes for acute promyelocytic leukemia (APL) have improved with all-trans-retinoic acid and arsenic trioxide, yet relapse remains a concern, especially in pediatric patients. The prognostic value of minimal residual disease (MRD) post-induction and the impact of arsenic levels during induction on MRD are not fully understood. Objectives: To evaluate the relationship between post-induction MRD levels and relapse-free survival (RFS) in pediatric APL patients, and to investigate the correlation between blood arsenic concentration levels during induction therapy and MRD status. Design: A retrospective analysis of pediatric APL patients enrolled in a clinical trial from September 2011 to July 2020. Methods: We assessed the relationship between RFS and post-induction MRD levels using the log-rank test. The optimal MRD cut-off was determined using the “surv_cutpoint” function in the survminer R package. Arsenic concentration levels were monitored in 16 patients on days 7 and 14 of induction therapy, and Spearman correlation was used to analyze the relationship between arsenic concentrations and MRD levels. Results: Among 176 pediatric APL patients, with a median follow-up of 6 years, 4 relapsed. Patients with MRD >3.1% had significantly lower RFS compared to those with MRD ⩽3.1% (94.6% vs 100%, p = 0.023). In addition, a negative correlation was found between blood arsenic concentration levels and post-induction MRD levels. Lower arsenic concentrations were associated with higher MRD levels, with significant correlations observed for trough concentrations ( R = −0.666, p = 0.005) and peak concentrations ( R = −0.499, p = 0.049) on day 7. Conclusion: Our study highlights the prognostic significance of post-induction MRD assessment in pediatric APL. We also demonstrate a negative correlation between blood arsenic concentration levels and MRD, suggesting that lower arsenic concentrations during induction therapy may contribute to a higher MRD burden. These findings may inform strategies to optimize treatment and improve outcomes in pediatric APL. Trial registration: www.clinicaltrials.gov (NCT02200978).https://doi.org/10.1177/20406207241311774 |
| spellingShingle | Zhong Fan Liang-Chun Yang Yi-Qiao Chen Wu-Qing Wan Dun-Hua Zhou Hui-Rong Mai Wan-Li Li Li-Hua Yang He-Kui Lan Hui-Qin Chen Bi-Yun Guo Zi-Jun Zhen Ri-Yang Liu Guo-Hua Chen Xiao-Qin Feng Cong Liang Li-Na Wang Yu-Li Jie-Si Luo Dan-Ping Huang Xue-Qun Luo Bin Li Li-Bin Huang Xiao-Li Zhang Yan-Lai Tang Prognostic significance of MRD and its correlation with arsenic concentration in pediatric acute promyelocytic leukemia: a retrospective study by SCCLG-APL group Therapeutic Advances in Hematology |
| title | Prognostic significance of MRD and its correlation with arsenic concentration in pediatric acute promyelocytic leukemia: a retrospective study by SCCLG-APL group |
| title_full | Prognostic significance of MRD and its correlation with arsenic concentration in pediatric acute promyelocytic leukemia: a retrospective study by SCCLG-APL group |
| title_fullStr | Prognostic significance of MRD and its correlation with arsenic concentration in pediatric acute promyelocytic leukemia: a retrospective study by SCCLG-APL group |
| title_full_unstemmed | Prognostic significance of MRD and its correlation with arsenic concentration in pediatric acute promyelocytic leukemia: a retrospective study by SCCLG-APL group |
| title_short | Prognostic significance of MRD and its correlation with arsenic concentration in pediatric acute promyelocytic leukemia: a retrospective study by SCCLG-APL group |
| title_sort | prognostic significance of mrd and its correlation with arsenic concentration in pediatric acute promyelocytic leukemia a retrospective study by scclg apl group |
| url | https://doi.org/10.1177/20406207241311774 |
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