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<p>The study aimed to investigate the effect of flow cytometry minimal residual disease (Flow-MRD)-guided posttransplant 6-mercaptopurine (6-MP)/methotrexate (MTX) maintenance on the prognosis in children with high-risk acute lymphoblastic leukemia (ALL). Forty individuals were divided into two groups: Group 1 (<i>n</i> = 16) received posttransplant 6-MP/MTX maintenance, while Group 2 (<i>n</i> = 24) did not. Posttransplant flow-MRD was monitored monthly for the first 100 days, then every three months for the next 365 days. All transplant data was recorded. After transplant, six patients (38%) in Group 1 and eleven (45%) in Group 2 had overt relapse. In Group 1, flow-MRD-directed maintenance was started in 11 patients within three months of transplantation, and in 5 patients six months later. Overt relapse occurred in two (20%) of eleven individuals and four (80%) of five patients on maintenance. Twelve (75%) of the 16 individuals in Group 1 experienced reversible grade 1–2 hematological and hepatic toxicity. Seven patients in Group 2 died from refractory leukemia within six months of transplantation, while the remaining four survived. Patients on maintenance had a significantly higher survival rate (82%) than those without maintenance (38%) (<i>p</i> &lt; 0.05). Risk variables for mortality included TBI-based conditioning, short posttransplant relapse time (&lt; 1 year), and bone marrow product use. This is the first pediatric study to assess the effect of posttransplant flow-MRD-guided 6-MP/MTX maintenance in high-risk ALL. This strategy may improve leukemia survival with minimal toxicity and low cost; however, further research is needed.</p>

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Effect of Minimal Residual Disease Guided Posttransplant 6-Mercaptopurine and Methotrexate Maintenance on Prognosis in Children with High-Risk Acute Lymphoblastic Leukemia: A Single-Center Experience

  • 期刊论文

  • 发表日期：

    2026年4月1日

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  • Zühre Kaya,
  • Ahmet Bayramlı,
  • Serap Kirkiz Kayalı,
  • Emine Yılmaz Orulluoğlu,
  • Ulker Koçak

摘要

The study aimed to investigate the effect of flow cytometry minimal residual disease (Flow-MRD)-guided posttransplant 6-mercaptopurine (6-MP)/methotrexate (MTX) maintenance on the prognosis in children with high-risk acute lymphoblastic leukemia (ALL). Forty individuals were divided into two groups: Group 1 (n = 16) received posttransplant 6-MP/MTX maintenance, while Group 2 (n = 24) did not. Posttransplant flow-MRD was monitored monthly for the first 100 days, then every three months for the next 365 days. All transplant data was recorded. After transplant, six patients (38%) in Group 1 and eleven (45%) in Group 2 had overt relapse. In Group 1, flow-MRD-directed maintenance was started in 11 patients within three months of transplantation, and in 5 patients six months later. Overt relapse occurred in two (20%) of eleven individuals and four (80%) of five patients on maintenance. Twelve (75%) of the 16 individuals in Group 1 experienced reversible grade 1–2 hematological and hepatic toxicity. Seven patients in Group 2 died from refractory leukemia within six months of transplantation, while the remaining four survived. Patients on maintenance had a significantly higher survival rate (82%) than those without maintenance (38%) (p < 0.05). Risk variables for mortality included TBI-based conditioning, short posttransplant relapse time (< 1 year), and bone marrow product use. This is the first pediatric study to assess the effect of posttransplant flow-MRD-guided 6-MP/MTX maintenance in high-risk ALL. This strategy may improve leukemia survival with minimal toxicity and low cost; however, further research is needed.