Prognostic factors affecting remissions based on minimal residual disease (MRD) examination in paediatric acute lymphoblastic leukaemia patients after induction phase treatment

Introduction: Acute lymphoblastic leukaemia (ALL) is the most common cancer in children. Remission in the induction phase plays an important role in the prognosis of ALL. Minimal residual disease (MRD) examination can detect cancer cell residues that cannot be detected by conventional morphological examination methods.

Objectives: To identify prognostic factors affecting ALL remissions at the end of the induction phase of chemotherapy treatment using MRD examination as the paediatric gold standard.

Method: This is a retrospective cohort study. Forty-six children diagnosed with ALL aged 1 to 18 years in the paediatric ward of Sanglah General Hospital, Bali, Indonesia were enrolled in this study from 2017 to 2019. Data with categorical variables were analysed using the Chi-Square test. A p-value <0.05 was considered statistically significant.

Results: A total of 46 subjects, aged 1 to 10 years, was included in this study. Twenty-five (54.3%) patients experienced relapse, 21 (45.7%) of them achieving remission by MRD examination at the end of the induction phase. Bivariate test results showed a significant difference in therapeutic response based on L1 type (p = 0.028) and platelet levels (p = 0.017). Multivariate test results showed a platelet level >30,000/ cu mm caused remission in ALL patients (CI 95% 1.486-28.326, p=0.013). The L1 type was significantly associated with treatment response (95% CI 0.013-0.617, p = 0.014).

Conclusions: Platelet levels >30.000/cu mm and L1 type of leukaemia are prognostic factors for remissions based on the examination of MRD in paediatric patients with ALL after the induction phase.

Sri Lanka Journal of Child Health, 2023; 52(1): 27-32