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Phase III FORUM trial: MRD status predicts transplant outcomes in pediatric ALL
Results from the randomized, international phase III FORUM trial comparing minimal residual disease (MRD) impact on hematopoietic stem cell transplantation (HSCT) outcomes in 1,014 children with acute lymphoblastic leukemia (ALL) were recently published in Haematologica by Balduzzi et al.
Key data: Pre-transplant MRD positivity (≥0.01%) significantly worsened 3-year event-free survival (0.59 vs 0.73; p < 0.001) and increased cumulative incidence of relapse (0.33 vs 0.20; p < 0.001) compared with MRD-negative patients. No detrimental effect of MRD positivity pre-HSCT could be demonstrated in patients with T-cell ALL.
Key learning: Pre-transplant MRD status represents a strong prognostic factor for pediatric ALL transplant outcomes, with MRD negativity (<0.01%) recommended prior to transplantation, particularly in B-ALL where the detrimental effect of MRD positivity was most pronounced.
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