ArticleBlood research2025
Improved survival in pediatric acute lymphoblastic leukemia through therapy intensification based on minimal residual disease and protocol-driven early response risk classification.
Article in Blood research, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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Who cites it
7 citing papers in PubMed.
- Understanding and clinical approach to early T-cell precursor acute lymphoblastic leukemia.Blood research · 2026Review
- Feasibility of therapeutic drug monitoring of asparaginase across multiple formulations in pediatric acute lymphoblastic leukemia.Blood research · 2026Article
- Effects of induction-phase acute kidney injury and age at diagnosis on chronic kidney disease in pediatric acute lymphoblastic leukemia: a time-to-event cohort study.Clinical and experimental pediatrics · 2026Article
- Risk Factors for Sepsis in Pediatric All During Induction Chemotherapy-Induced Neutropenia: A Single-Center Retrospective Study.Infection and drug resistance · 2026Article
- A Large Concept Model for Mechanistic Simulation of Disease Trajectories: A Hypothesis-Generating Exemplar for Pediatric Acute Lymphoblastic Leukemia.Computational and structural biotechnology journal · 2026Article
- Clinical outcomes in pediatric acute lymphoblastic leukemia: a retrospective cohort study from a tertiary center in Indonesia.Frontiers in pediatrics · 2026Article
- Landscape assessment to characterize baseline access and multilevel barriers to IMProve Access to CAR-T CD19 therapy (IMPACT study) across Europe.medRxiv : the preprint server for health sciences · 2025Article
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10 authors.
Funding
Abstract
purposeMinimal residual disease (MRD)-guided therapy is the global standard treatment for pediatric acute lymphoblastic leukemia (ALL). We assessed the impact of MRD-driven intensification along with protocol-defined risk groups in pediatric ALL treatment.
methodsThis retrospective analysis included 209 patients with ALL (treated between January 2013 to June 2023). MRD was assessed using six- to eight-color flow cytometry at the end of each phase before the maintenance phase. Post-induction treatment was determined based on early response, National Cancer Institute risk, and cytogenetics. High-risk (HR) patients followed the Korean HR or CCG-1882 protocols and standard-risk (SR) patients followed the modified COG-AALL0331 protocol. Treatment was intensified if flow-MRD ≥ 0.1% was identified.
resultsOverall, 103 and 106 patients were classified as having SR and HR, respectively. The 5-year overall survival (OS) and event-free survival (EFS) were 92.5% and 84.3%, respectively. Thirty SR and 18 HR patients received intensified chemotherapy. Treatment intensification significantly improved EFS in patients with high MRD (94.2% vs. 75.5%, p = 0.04), particularly in post-induction patients with high MRD (90.0% vs. 19.0%, p = 0.035). The difference in survival between rapid early responder (RER) and slow early responder (SER) groups was eliminated after MRD-based intensification. The implementation rates of treatment intensification varied over time (9.1% before 2015, 28.6% during 2016-2019, and 13.9% during 2020-2023), reflecting improved risk stratification and therapy selection.
conclusionMRD-guided therapy intensification markedly improved survival outcomes in patients with pediatric ALL when combined with risk-based protocols, highlighting the importance of MRD monitoring for optimizing risk-adapted treatment strategies.
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