Table 3.

Outcomes of Patients with Leukemia and Post-Transplant Minimal Residual Disease

Patient #	Disease	Pre-HCT Disease Status	Transplant Conditioning	Donor	Days from HCT to detection of Post- HCT MRD	% MRD1	Mode of detection	Days from HCT to overt relapse	Days from HCT to first intervention	Intervention	Survival after HCT (Days)	Cause of Death	Disease status at last evaluation
2	ALL	+ BCR-ABL 0.01% by RT-PCR only, flow negative	MA (Cy/TBI)	MSD	60	0.01	Flow cytometric and cytogenetic, + BCR-ABL PCR	84	90	Chemo	115	Multi-system organ failure	PD
6		0.29% MRD by flow	MA (Cy/TBI)	MSD	56	0.01	Flow cytometric	N/A	70	DLI	83	CMV PNA, ARDS	None performed prior to death
76		+BCR-ABL 0.03% by RT-PCR only, flow negative	NMA	Haploidentical	35	BCR-ABL detection by RT-PCR, non-quantifiable	Cytogenetic	Increasing copies of BCR-ABL without overt relapse	No treatment initiated due to ongoing toxicities post HCT	N/A	153	Adenovirus, pulmonary hemorrhage, fungal infection	CR
46	AML	MRD Negative CR	NMA	Haploidentical	30	0.08	Cytogenetic	51	30*	WIS→ 2nd HCT	247	Multi-system organ failure, GVHD, Sepsis	CR
49		1% by flow	NMA	Haploidentical	29	3	Flow cytometric	50	52	Chemo + DLI	81	Sepsis	PD
63		Refractory Disease	MA (Bu/Cy)	MUD	64	1	Flow cytometric	77	69*	WIS → Chemo	138	Sepsis	PD
65		Refractory Disease, CNS negative	MA (Bu/Cy)	MUD	28	2 to 3	Flow cytometric	45	29*	WIS→ Chemo	150	VOD, GVHD	PD

¹Indicates the level of disease detected at the first evidence for minimal residual disease. Specifically, for those patients who presented at day 56, 60 and 64 prior disease restaging at 1 month post-transplant was negative.

^*Indicates that therapy was initiated prior to overt relapse.

HCT=hematopoietic cell transplantation; MRD=minimal residual disease; WIS=withdrawal of immunosuppression; DLI=donor lymphocyte infusion; CMV=cytomegalovirus; PNA=pneumonia; ARDS=acute respiratory distress syndrome; GVHD=graft-versus host disease; CR=complete remission; PD=progressive disease; ALL=acute lymphoblastic leukemia; AML=acute myelogenous leukemia; Chemo=chemotherapy; MA=myeloablative; Cy=cyclophosphamide; TBI=Total body irradiation; Bu=busulfan; NMA=non-myeloablative; MSD=matched sibling donor; MUD=matched unrelated donor