Measurable Residual Disease Monitoring During Treatment for Pediatric Acute Myeloid Leukemia in First Relapse

Fecha de publicación: 01/01/2026

Autores de IIS La Fe

José María Fernández Navarro

Autor

Participantes ajenos a IIS La Fe

Poulsen C.
Sandahl K.J.
Karlsson L.
Abrahamsson J.
Arad-Cohen N.
Cheuk D.
De Moerloose B.
Fogelstrand L.
Goemans B.F.
Jahnukainen K.
Kaspers G.
Kovalova Z.
Munthe-Kaas M.C.
Norén-Nyström U.
Palle J.
Pasauliene R.
Pronk C.J.
Saks K.
Tierens A.
Hasle H.
Juul-Dam K.L.

Grupos

Investigación Clínica y Traslacional en Cáncer

Abstract

Background: Survival after relapse in pediatric acute myeloid leukemia (AML) remains poor, highlighting the critical importance of identifying prognostic factors to guide optimal relapse management. Methods: We investigated the prognostic impact of multiparameter flow cytometry (MFC) measurable residual disease (MRD) in 188 patients with first relapse after initial treatment according to the NOPHO-DBH AML 2012 protocol. Results: The 4-year overall survival (OS4y) was 44% (95% confidence interval [CI]: 36%–51%). OS4y was 61% (CI: 51%–69%) in 133/188 patients who received stem cell transplantation (SCT) after reinduction therapy. Nineteen patients treated at the time of molecular relapse showed an excellent OS4y of 84% (CI: 58%–95%). Patients with hematological relapse and MRD <0.1% after first reinduction course had a superior OS4y of 69% (CI: 51%–81%) compared to patients with MRD between 0.1% and 4.9% (OS4y 46%, CI:28%–63%) and MRD =5% (OS4y 16%, CI: 6%–30%), adjusted hazard ratio (HR) 2.2 for MRD 0.1%–4.9%; p = 0.04 and HR 6.0 for MRD =5%; p < 0.001. Patients in second complete remission after first reinduction course and MRD <0.1% after second reinduction course had an OS4y of 70% (CI: 52%–82%) compared to 46% (CI: 19%–70%) in patients with MRD =0.1%, HR 2.7; p = 0.048. OS4y was 71% (CI: 54%–82%) and 31% (CI: 13%–51%) for patients with MRD <0.1% or =0.1% prior to SCT, respectively, HR 3.1; p = 0.004. Conclusions: This study identifies MFC MRD during reinduction therapy and before SCT as novel and independent predictors of outcome in relapsed pediatric AML. © 2026 The Author(s). Pediatric Blood & Cancer published by Wiley Periodicals LLC.

Datos de la publicación

ISSN/ISSNe:: 1545-5009, 1545-5017
Tipo:: Article
Páginas:: -
DOI:: 10.1002/1545-5017.70513
PubMed:: 42504451
Enlace a otro recurso:: www.scopus.com
Factor de Impacto:: 1,009 SCImago ℠
Cuartil:: Q1 SCImago ℠

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Filiaciones

Poulsen C.:: Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
Sandahl K.J.:: Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
Karlsson L.:: Department of Pediatrics, Institution for Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
Abrahamsson J.:: Department of Pediatrics, Institution for Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
Arad-Cohen N.:: Department of Pediatric Hemato-Oncology, Rambam Health Care Campus, Haifa, Israel
Cheuk D.:: Department of Pediatrics and Adolescent Medicine, Hong Kong Children's Hospital and The University of Hong Kong, Hong Kong

Hong Kong Pediatric Hematology and Oncology Study Group (HKPHOSG), Hong Kong
De Moerloose B.:: Department of Pediatric Hematology-Oncology, Ghent University Hospital, Gent, Belgium
Fogelstrand L.:: Department of Laboratory Medicine, Institute of Biomedicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden

Department of Clinical Chemistry, Sahlgrenska University Hospital, Region Vastra Gotaland, Gothenburg, Sweden
Navarro J.M.F.:: Department of Pediatric Hemato-Oncology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
Goemans B.F.:: Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
Jahnukainen K.:: New Children's hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
Kaspers G.:: Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands

Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Pediatric Oncology, Amsterdam, Netherlands
Kovalova Z.:: Department of Paediatric Oncology/Haematology, Children's Clinical University Hospital, Riga, Latvia

Rigas Stradinsh University, Riga, Latvia
Munthe-Kaas M.C.:: Department of Pediatric Oncology and Hematology, Oslo University Hospital, Oslo, Norway
Norén-Nyström U.:: Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
Palle J.:: Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
Pasauliene R.:: Center of Oncology and Hematology, BMT Unit, Vilnius University Children's Hospital, Vilnius, Lithuania
Pronk C.J.:: Childhood Cancer Center, Skåne University Hospital, Lund, Sweden

Medical Faculty, Lund University, Lund, Sweden
Saks K.:: Department of Paediatrics, SA Tallinna Lastehaigla, Tallinn, Estonia
Tierens A.:: Laboratory Medicine Program, University Health Network, Toronto General Hospital, Toronto, ON, Canada
Hasle H.:: Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
Juul-Dam K.L.:: Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark

Keywords

acute myeloid leukemia; measurable residual disease; pediatrics; relapse

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