Prognostic significance of minimal residual disease in infants with acute lymphoblastic leukemia treated within the Interfant-99 protocol

Interfant-99 Study Group, V H J Van der Velden, L Corral, M G Valsecchi, M W J C Jansen, P De Lorenzo, G Cazzaniga, E R Panzer-Grümayer, M Schrappe, A Schrauder, C Meyer, R Marschalek, L L Nigro, M Metzler, G Basso, G Mann, M L Den Boer, A Biondi, R Pieters, J J M Van Dongen

Research output: Contribution to journalArticlepeer-review

125 Citations (Scopus)


Acute lymphoblastic leukemia (ALL) in infants younger than 1 year is a rare but relatively homogeneous disease ( approximately 80% MLL gene rearranged, approximately 70% CD10-negative) when compared with childhood and adult ALL. Several studies in children and adults with ALL have shown that minimal residual disease (MRD) status is a strong and independent prognostic factor. We therefore evaluated the prognostic significance of MRD in infant ALL. Ninety-nine infant patients treated according to the Interfant-99 protocol were included in this study. MRD was analyzed by real-time quantitative PCR analysis of rearranged immunoglobulin genes, T-cell receptor genes and MLL genes at various time points (TP) during therapy. Higher MRD levels at the end of induction (TP2) and consolidation (TP3) were significantly associated with lower disease-free survival. Combined MRD information at TP2 and TP3 allowed recognition of three patients groups that significantly differed in outcome. All MRD-high-risk patients (MRD levels > or =10(-4) at TP3; 26% of patients) relapsed. MRD-low-risk patients (MRD level <10(-4) at both TP2 and TP3) constituted 44% of patients and showed a relapse-rate of only 13%, whereas remaining patients (MRD-medium-risk patients; 30% of patients) had a relapse rate of 31%. Comparison between the current Interfant-06 stratification at diagnosis and the here presented MRD-based stratification showed that both stratifications recognized different subgroups of patients. These data indicate that MRD diagnostics has added value for recognition of risk groups in infant ALL and that MRD diagnostics can be used for treatment intervention in infant ALL as well.

Original languageEnglish
Pages (from-to)1073-9
Number of pages7
Issue number6
Publication statusPublished - Jun 2009
Externally publishedYes


  • Antineoplastic Combined Chemotherapy Protocols/therapeutic use
  • Follow-Up Studies
  • Gene Rearrangement
  • Genes, Immunoglobulin
  • Histone-Lysine N-Methyltransferase
  • Humans
  • Infant
  • Infant, Newborn
  • Myeloid-Lymphoid Leukemia Protein/genetics
  • Neoplasm, Residual/diagnosis
  • Polymerase Chain Reaction
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma/diagnosis
  • Prognosis
  • Receptors, Antigen, T-Cell/genetics
  • Recurrence
  • Treatment Outcome


Dive into the research topics of 'Prognostic significance of minimal residual disease in infants with acute lymphoblastic leukemia treated within the Interfant-99 protocol'. Together they form a unique fingerprint.

Cite this