The Different Impacts of an MRD-Guided Protocol on Relapse of Childhood Acute Lymphoblastic Leukemia: The Report of Taiwan Pediatric Oncology Group (TPOG)-ALL-2013

Taiwan Pediatric Oncology Group (TPOG)-ALL-2013 protocol (TPOG-2013), modifying from St. Jude Total Therapy XV Study and Total Therapy XVI Study, was launched since January 2013. This is the first nationwide minimal residual disease (MRD)-directed protocol for treatment of childhood acute lymphoblas...

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Published in:Blood 2023-11, Vol.142 (Supplement 1), p.1462-1462
Main Authors: Liu, Hsi-Che, Jou, Shiann-Tarng, Chen, Shih-Hsiang, Jaing, Tang-Her, Yeh, Ting-Chi, Chen, Jiann-Shiuh, Wu, Kang-Hsi, Wang, Shih-Chung, Hsiao, Chih-Cheng, Chang, Te-Kau, Lu, Meng-Yao, Yen, Hsiu-Ju, Huang, Fang-Liang, Chen, Shu-Huey, Yang, Shang-Hsien, Liu, Yen-Lin, Chiou, Shyh-Shin, Yang, Chao-Ping, Shih, Lee-Yung, Lin, Dong-Tsamn
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Language:English
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Summary:Taiwan Pediatric Oncology Group (TPOG)-ALL-2013 protocol (TPOG-2013), modifying from St. Jude Total Therapy XV Study and Total Therapy XVI Study, was launched since January 2013. This is the first nationwide minimal residual disease (MRD)-directed protocol for treatment of childhood acute lymphoblastic leukemia (ALL) in Taiwan. According to TPOG-2013, two MRD measurements were scheduled on days 15-19 of induction (MRD1 time point, TP1) and days 35-42, end of induction (MRD2 time point, TP2) to make the definitive risk stratification to guide subsequent therapy. As of April 30, 2023, 814 newly diagnosed ALLs treated with TPOG-2013 and followed up ≥3 years were enrolled in the study. The outcomes were compared with those of TPOG-ALL-2002 protocol (TPOG-2002) (N=1350, between January 2002 and December 2012), which did not integrate the MRD monitoring. The 5-year event-free survival and overall survival were significantly improved from 76% (95% CI, 74-78) and 81% (80-84) of TPOG-2002 to 86% (83-88) and 89% (87-92) of TPOG-2013, respectively ( P< 0.0001). For further analysis of TPOG-2013, 585 (72%) patients with exact adherence (EA) to both TPs were assigned as MRD EA group; 225 patients who were non-adherence (NA) to either one of TPs as MRD NA group; and four patients were excluded for the comparative outcome analysis. For B-cell precursor (BCP) ALL, the 5-year cumulative incidence of relapse (CIR) significantly decreased from TPOG-2002 (N=1194) to TPOG-2013 MRD EA (N=527) ( P
ISSN:0006-4971
1528-0020
DOI:10.1182/blood-2023-186805