RISK STRATIFICATION AND MINIMAL RESIDUAL DISEASE AFTER INDUCTION CHEMOTHERAPY IN PATIENTS WITH ACUTE LYMPHOBLASTIC LEUKAEMIA
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Keywords
Acute lymphoblastic leukaemia, Minimal residual disease, Risk stratification, Cytogenetics, Induction chemotherapy.
Abstract
Background: Acute lymphoblastic leukaemia (ALL) is a heterogeneous malignancy where treatment outcomes depend on multiple prognostic factors. Minimal residual disease (MRD) monitoring following induction chemotherapy has emerged as a powerful tool for assessing response and refining risk stratification. Methods: This prospective observational study was conducted at the Department of Haematology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh, from July 2021 to June 2022. A total of 86 newly diagnosed ALL patients were enrolled. Diagnosis was based on morphology, cytochemistry, immunophenotyping and cytogenetics. All patients received standard induction chemotherapy and MRD status was assessed post-induction. Associations between MRD outcome, risk stratification and cytogenetic profiles were analyzed. Results: Among 86 patients, 48 (55.8%) were categorized as standard risk and 38 (44.2%) as high risk. Post-induction MRD analysis showed that 54 patients (62.8%) achieved MRD negativity, while 32 (37.2%) remained MRD-positive. A significant association was found between risk group and MRD outcome: 83.3% of standard-risk patients achieved MRD negativity compared to 36.8% of high-risk patients (p < 0.001). Cytogenetics also influenced outcomes: favorable abnormalities had the highest MRD negativity rate (88.9%), unfavorable abnormalities showed poor clearance with 75.0% MRD positivity, while normal/other profiles yielded intermediate results (p = 0.002). Conclusion: MRD assessment after induction therapy provides critical prognostic information in ALL. Standard-risk and favorable cytogenetic patients were more likely to achieve MRD negativity, whereas high-risk and unfavorable groups demonstrated persistent disease. Incorporating MRD monitoring can enhance risk stratification and guide post-induction treatment decisions.
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Dr. Md. Adnan Hasan Masud
Consultant, Department of General Emergency, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
Dr. Gazi Yeasinul Islam
Medical Officer, Department of Haematology and BMT, Dhaka Medical College Hospital, Dhaka, Bangladesh
Dr. Kazi Mohammad Kamrul Islam
Research Assistant, Department of General Emergency, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
Dr. Md. Abdul Aziz
Professor, Department of Haematology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh