The significance of graft-versus-host disease and pretransplantation minimal residual disease status to outcome after allogeneic stem cell transplantation in patients with acute lymphoblastic leukemia

Relapse is the major cause of treatment failure after allogeneic stem cell transplantation (SCT) in patients with acute lymphoblastic leukemia. Minima l residual disease (MRD) was analyzed before SCT in 30 patients with acute lymphoblastic leukemia. The aim was to determine whether the level of MRD b efore transplantation was correlated with outcome. Fifteen patients were fo und to have high-level MRD (10(-2) to 10(-3)), 10 had low-level MRD (< 10(- 3)), and 5 were MRD-. Among MRD- patients the probability of relapse was 0 in 5, which was less than in MRD+ patients (13 of 25) (P = .05). No major d ifference was found between the high- and low-level MRD+ groups. Among the MRD+ patients, only 2 of 11 with acute and chronic graft-versus-host diseas e had a relapse, versus 11 of 14 without (P = .005). In conclusion, for pat ients entering transplantation While they have residual disease, a combinat ion of acute and chronic graft-versus-host disease may be needed to decreas e the risk of relapse after SCT.