MRD Detection by NGS in Pediatric B-ALL

Minimal Residual Disease Detection by Next-generation Sequencing of Different Immunoglobulin Gene Rearrangements in Pediatric B-ALL

This retrospective analysis aims to investigate pediatric patients with B-cell acute lymphoblastic leukemia who were detected for minimal residual disease (MRD) using next-generation sequencing (NGS). The study will utilize second-generation sequencing technology to analyze the rearrangement of the immunoglobulin heavy chain (IGH), immunoglobulin kappa light chain (IGK), and immunoglobulin lambda light chain (IGL) genes in these patients. Patients will be stratified based on NGS-MRD levels, and the relationship between NGS-MRD and Event-Free Survival (EFS) will be evaluated.

Study Overview

• Status: Completed
• Conditions: Acute Lymphoblastic Leukemia, Pediatric
• Intervention / Treatment: Other: MRD

Detailed Description

Study Design, Patients, and Procedures This was a prospective, single-center, observational study conducted in children with ALL between November 2018 and June 2022. Children with newly diagnosed B-ALL who undergone NGS of B-cell receptors at the Children's Hospital of Zhejiang University School of Medicine were included in this study.

The European Group for the Immunological Characterization of Leukemias (EGIL) criteria were applied to diagnose and classify ALL in this study. All enrolled patients were treated according to the ZJCH-ALL-2019 protocol detailed in the supplementary file. This protocol was implemented in our center in September 2018 and subsequently extended to all of Zhejiang Province in 2019. In this protocol, NGS-MRD was not used for patient risk stratification or treatment allocation. For the detection of MRD, bone marrow (BM) aspiration for Ig NGS was collected at diagnosis, the end of induction (EOI) at the 5th week from the initial prednisone prephase, and the end of consolidation (EOC) at the 13th week which was before the start of early intensification for low and intermediate risk patients, and was before the start of the second course of consolidation for high-risk patients. NGS-MRD was sequentially monitored every 2 to 3 months after consolidation until it was undetectable. In this study, NGS-MRD refers to the quantitative value of MRD detected through NGS testing which was the sum of IGH and light chain (IGK/IGL) levels. NGS detection during other timepoints, such as the interim of induction and timepoints after NGS-MRD was negative, was not mandatory but monitored as per parents' preference. The patients were followed up until August 30, 2022 and the median follow-up time was 20.7 months.

Statistical Analysis The association between categorical variables was tested using χ2 test, the correlation between quantitative variables was measured using Pearson correlation and tested using Student's t distribution, and ANOVA was used to compare quantitative variables. Event-free survival (EFS) and overall survival (OS) curves were estimated using the Kaplan-Meier method and compared according to the log rank test. Death during induction, abandonment before complete remission, death in continuous complete remission, relapse, and secondary malignancies were considered as events in the calculation of EFS probability. The EFS time was calculated from the date of diagnosis to the last date of follow-up or the first event. The OS was calculated from the date of diagnosis to death from any causes with censoring the patients alive at the time of data analysis. The final date for follow-up was August 30, 2022. Data visualization was performed using R package ggplot2 (Version 4.0.3) and GraphPad Prism 9.0.0. Statistical analysis was performed on R (Version 4.0.3). A P value of <0.05 (2 tailed) was considered to be statistically significant.

• Study Type: Observational
• Enrollment (Actual): 430

Contacts and Locations

Study Locations

• China
  • Zhejiang
    • Hangzhou, Zhejiang, China, 310003
      • The Children's Hospital of Zhejiang University School of Medicine

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Probability Sample

Study Population

Children under the age of 18 years diagnosed with acute B-cell lymphoblastic leukemia between 2018 and 2022.

Description

Inclusion Criteria:

• Children with newly diagnosed B-ALL who undergone NGS of B-cell receptors
• Children older than 1 year receive treatment according to the ZJCH-ALL-2019 protocol, while children younger than 1 year receive treatment according to the infant leukemia protocol.

Exclusion Criteria:

• B-cell acute lymphoblastic leukemia (B-ALL) patients who have not undergone high-throughput sequencing.
• Treated according to other protocols.

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
MRD positive and MRD negative groups; MRD postive: NGS-MRD>=0.01% at the end of induction or >=0.0001% at the end of consoidation. MRD negative: NGS-MRD<0.01% at the end of induction or <0.0001% at the end of consoidation.	Other: MRD; Calculate the 3-year EFS based on the MRD status (MRD positive and negative groups)

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
event-free survival	The EFS time was calculated from the date of diagnosis to the last date of follow-up or the first event.	Between November 2018 and June 2022

Collaborators and Investigators

• Sponsor: The Children's Hospital of Zhejiang University School of Medicine

Study record dates

Study Major Dates

• Study Start (Actual): November 1, 2018
• Primary Completion (Actual): August 31, 2022
• Study Completion (Actual): August 31, 2022

Study Registration Dates

• First Submitted: July 25, 2023
• First Submitted That Met QC Criteria: July 25, 2023
• First Posted (Actual): August 2, 2023

Study Record Updates

• Last Update Posted (Actual): January 24, 2024
• Last Update Submitted That Met QC Criteria: January 23, 2024
• Last Verified: July 1, 2023

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Immune System Diseases; Neoplasms by Histologic Type; Neoplasms; Lymphoproliferative Disorders; Lymphatic Diseases; Immunoproliferative Disorders; Leukemia, Lymphoid; Leukemia; Precursor Cell Lymphoblastic Leukemia-Lymphoma
• Other Study ID Numbers: 2023-IRB-0062

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No