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Hayashi RJ, Hermiston ML, Wood BL, Teachey DT, Devidas M, Chen Z, Annett RD, Asselin BL, August K, Cho S, Dunsmore KP, Freedman JL, Galardy PJ, Harker-Murray P, Horton TM, Jaju A, Lam A, Messinger YH, Miles RR, Okada M, Patel S, Schafer ES, Schechter T, Shimano KA, Singh N, Steele A, Sulis ML, Vargas S, Winter SS, Wood C, Zweider-McKay PA, Loh ML, Hunger SP, Raetz EA, Bollard CM, Allen CE. MRD at the End of Induction and EFS in T-cell Lymphoblastic Lymphoma: Children's Oncology Group Trial AALL1231. Blood 2024:blood.2023021184. [PMID: 38457359 DOI: 10.1182/blood.2023021184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 02/12/2024] [Accepted: 02/14/2024] [Indexed: 03/10/2024] Open
Abstract
Defining prognostic variables in T-lymphoblastic lymphoma (T-LL) remains a challenge. AALL1231 was a COG phase 3 clinical trial for newly diagnosed with T Acute Lymphoblastic leukemia or T-LL patients randomizing children and young adults to a modified augmented BFM backbone to receive standard therapy (Arm A) or with addition of bortezomib (Arm B). Optional bone marrow (BM) samples to assess minimal residual disease (MRD) at the end of induction (EOI) were collected in T-LL analyzed to assess the correlation of MRD at the EOI to event-free survival (EFS). Eighty-six (41%) of the 209 T-LL patients accrued to this trial submitted samples for MRD assessment. Patients with MRD <0.1% (n= 75) at EOI had a superior 4-year EFS versus those with MRD >0.1% (n= 11), (89.0±4.4% versus 63.6±17.2%, p= 0.025). Overall survival did not significantly differ between the two groups. Cox regression for EFS using Arm A as a reference demonstrated that MRD EOI ≥0.1% was associated with a greater risk of inferior outcome (Hazard Ratio, HR= 3.73 (1.12-12.40, p= 0.032), which was independent of treatment arm assignment. Consideration to incorporate MRD at EOI into future trials will help establish its value in defining risk groups. CT# NCT02112916.
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Affiliation(s)
- Robert J Hayashi
- Washington University in St. Louis School of Medicine, St. Louis, Missouri, United States
| | - Michelle L Hermiston
- University of California, San Francisco, San Francisco, California, United States
| | - Brent L Wood
- Childrens Hospital Los Angeles, Los Angeles, California, United States
| | | | - Meenakshi Devidas
- St Jude Children's Research Hospital, Memphis, Tennessee, United States
| | - Zhiguo Chen
- University of Florida, Gainesville, Florida, United States
| | - Robert D Annett
- University of New Mexico Health Sciences Center, Albuquerque, New Mexico, United States
| | - Barbara L Asselin
- University of Rochester Medical Center, Rochester, New York, United States
| | - Keith August
- Children's Mercy Hospital, Kansas City, Missouri, United States
| | - Steve Cho
- Wisconsin Institute for Medical Research, United States
| | | | | | | | | | - Terzah M Horton
- Baylor College of Medicine/Dan L. Duncan Cancer Center and Texas Children's Cancer Center, Houston, Texas, United States
| | - Alok Jaju
- Phoenix Children's Hospital, Phoenix, Arizona, United States
| | | | - Yoav H Messinger
- Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota, United States
| | - Rodney R Miles
- University of Utah -- Huntsman Cancer Institute, Salt Lake City, Utah, United States
| | - Maki Okada
- University of Alberta- Stollery Children's Hospital, Edmonton, AB, Canada, United States
| | | | | | | | - Kristin A Shimano
- University of California San Francisco, San Francisco, California, United States
| | - Neelam Singh
- Michigan State University Clinical Center, East Lansing, Michigan, United States
| | - Amii Steele
- Carolinas Medical Center/Levine Cancer Institute, Charlotte, North Carolina, United States
| | - Maria Luisa Sulis
- Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Sarah Vargas
- childrens oncology group, Monrovia, California, United States
| | | | - Charlotte Wood
- University of Florida, gainesville, Florida, United States
| | | | - Mignon L Loh
- Seattle Children's Hospital, the Ben Town Center for Childhood Cancer Research, University of Washington, Seattle, WA., Seattle, Washington, United States
| | - Stephen P Hunger
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
| | | | | | - Carl E Allen
- Baylor College of Medicine, Houston, Texas, United States
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Serrallach BL, Schafer ES, Kralik SK, Tran BH, Huisman TAGM, Wright JN, Morgan LA, Desai NK. Imaging Findings in Children Presenting with CNS Nelarabine Toxicity. AJNR Am J Neuroradiol 2022; 43:1802-1809. [PMID: 36328408 DOI: 10.3174/ajnr.a7692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 09/29/2022] [Indexed: 11/06/2022]
Abstract
Nelarabine is a nucleoside analog critical for the treatment of patients with T-cell acute lymphoblastic leukemia/lymphoma. However, clinical peripheral and central neurologic adverse events associated with nelarabine administration have been reported. Neuroimaging of brain neurotoxicity has only been described in very few reports in pediatric patients so far. Six children with diagnosed T-cell acute lymphoblastic leukemia who clinically experienced possible, probable, or definite nelarabine-induced toxicity and underwent spine and/or brain MR imaging were reviewed. Neuroimaging findings showed a mixture of patterns including features of acute toxic leukoencephalopathy (seen in 6 cases), posterior reversible encephalopathy syndrome (2 cases), involvement of deep gray structures (1 case) and brainstem (2 cases), cranial and spinal neuropathy (2 cases each), and myelopathy (2 cases). Even though neuroimaging findings are nonspecific, the goal of this article was to alert the pediatric neuroradiologists, radiologists, and clinicians about the possibility of nelarabine-induced neurotoxicity and its broad neuroimaging spectrum.
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Affiliation(s)
- B L Serrallach
- From the Edward B. Singleton Department of Radiology (B.L.S., S.K.K., B.H.T., T.A.G.M.H., N.K.D.)
| | - E S Schafer
- Department of Pediatrics (E.S.S.), Section of Hematology-Oncology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | - S K Kralik
- From the Edward B. Singleton Department of Radiology (B.L.S., S.K.K., B.H.T., T.A.G.M.H., N.K.D.)
| | - B H Tran
- From the Edward B. Singleton Department of Radiology (B.L.S., S.K.K., B.H.T., T.A.G.M.H., N.K.D.)
| | - T A G M Huisman
- From the Edward B. Singleton Department of Radiology (B.L.S., S.K.K., B.H.T., T.A.G.M.H., N.K.D.)
| | | | - L A Morgan
- Neurology (L.A.M.), Division of Child Neurology, Seattle Children's Hospital, Seattle, Washington
| | - N K Desai
- From the Edward B. Singleton Department of Radiology (B.L.S., S.K.K., B.H.T., T.A.G.M.H., N.K.D.)
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