Evidence map›Paper›PMID 42150607›Full record

ArticleEuropean journal of haematology2026

Combined Early Steroid Response and MRD Improve Risk Stratification in Pediatric Acute Lymphoblastic Leukemia: The CCCG-ALL-2015 Study.

Wenxin Ou, Yi Yu, Xiaohua Zhu, Junye Jiang, Ping Cao, Jianhua Meng, Jun Le, Yang Fu, Zifeng Li, Jie Man and 4 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in European journal of haematology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

What it found

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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors.

Wenxin OuDepartment of Hematology and Oncology, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China.ORCID https://orcid.org/0000-0001-9929-5619
Yi YuDepartment of Hematology and Oncology, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China.
Xiaohua ZhuDepartment of Hematology and Oncology, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China.
Junye JiangDepartment of Hematology and Oncology, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China.
Ping CaoDepartment of Hematology and Oncology, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China.
Jianhua MengDepartment of Hematology and Oncology, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China.
Jun LeDepartment of Hematology and Oncology, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China.
Yang FuDepartment of Hematology and Oncology, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China.ORCID https://orcid.org/0000-0002-0378-2410
Zifeng LiDepartment of Hematology and Oncology, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China.ORCID https://orcid.org/0000-0001-9409-3452
Jie ManDepartment of Hematology and Oncology, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China.
Zhiyi WangDepartment of Hematology and Oncology, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China.
Maoxiang QianShanghai Key Laboratory of Birth Defects, Children's Hospital of Fudan University, National Children's Medical Center, and Shanghai Key Laboratory of Medical Epigenetics, International Co-Laboratory of Medical Epigenetics and Metabolism (Ministry of Science and Technology), Institutes of Biomedical Sciences, Fudan University, Shanghai, China.
Hongsheng WangDepartment of Hematology and Oncology, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China.
Xiaowen ZhaiDepartment of Hematology and Oncology, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China.ORCID https://orcid.org/0000-0002-3505-0302

Funding

National Key Research and Development Program of China 2023YFC2706301Shanghai Municipal Committee of Science and Technology 24Y12800602VIVA China Children's Cancer Foundation
6 · The paper itself

Abstract

objectiveTo determine whether early dexamethasone response provides complementary prognostic information to minimal residual disease (MRD) and whether integrating both markers refines risk stratification in pediatric acute lymphoblastic leukemia (ALL).

methodsWe retrospectively analyzed pediatric ALL patients treated at a single center according to the CCCG-ALL-2015 protocol. Day 5 steroid response was classified as dexamethasone good response (DGR) or dexamethasone poor response (DPR). Bone marrow MRD was measured on Days 19 and 46 of induction. A four-quadrant classification was constructed by combining Day 5 steroid response with Day 46 MRD status (DGR/MRD-, DGR/MRD+, DPR/MRD-, DPR/MRD+) to evaluate event-free survival (EFS) and cumulative incidence of relapse (CIR).

resultsAmong 312 patients, 220 were DGR and 92 were DPR. MRD negativity rates on Days 19 and 46 were significantly lower in DPR. Among 304 patients with paired MRD measurements, 181, 102, 18, and 3 patients were classified as D19-/D46-, D19+/D46-, D19+/D46+, and D19-/D46+, respectively, with progressively worse 5-year EFS and increasing 5-year CIR. In the four-quadrant analysis, EFS differed significantly across groups, and compared with DGR/MRD-, the other quadrants exhibited higher event risk. In multivariable Cox models, Day 46 MRD remained independently associated with inferior EFS (HR = 2.429, 95% CI: 1.286-4.590; p = 0.006). When the four-quadrant classification was entered into the multivariable model (reference: DGR/MRD-), DGR/MRD+ (HR = 4.319, 95% CI 1.792-10.414; p = 0.001), DPR/MRD- (HR = 2.207, 95% CI: 1.253-3.888; p = 0.006), and DPR/MRD+ (HR = 3.718, 95% CI: 1.608-8.598; p = 0.002) were each associated with increased event risk.

conclusionsMRD kinetics identify patients with delayed clearance or persistent positivity at higher relapse risk. Integrating early steroid response with MRD using a four-quadrant framework may complement MRD-based assessment and further refine risk stratification by highlighting clinically meaningful discordant subgroups.

Indexed as

Antineoplastic AgentsDexamethasoneGlucocorticoidsOutcome Assessment, Health CarePrecursor Cell Lymphoblastic Leukemia-LymphomaAdolescentBone MarrowChildChild, PreschoolFemaleHumansIncidenceInfantMaleNeoplasm Recurrence, LocalNeoplasm, ResidualAntineoplastic AgentsDexamethasoneGlucocorticoidsglucocorticoid responseinduction therapyminimal residual diseasepediatric acute lymphoblastic leukemiarisk stratification

Identifiers

PMID42150607
PMCPMC13542950

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