Detection of residual tumor at the postinduction stages of therapy is an independent unfavorable factor of relapse development in adult patients with acute lymphoblastic leukemia. Use of additional molecular markers, such as rearrangement of the IgH heavy chain and T-cell receptor (TCR) genes, allows high sensitivity monitoring of the minimum residual disease (MRD). The IgH and TCR clonal restructuring was studied in 26 patients with de novo ALL. Forty-two clonal restructurings were detected in 22 (85%) of 26 patients. High-dose consolidating chemotherapy was carried out in 15 of 22 patients. The results of MRD monitoring were evaluated in 12 patients. On day 70 of therapy MRD was detected in 9 patients. On day 133 7 of 12 patients developed no molecular remission. Only 6 patients were in molecular remission after high-dose consolidating chemotherapy (day 161). Despite the little number of patients in the study, we conclude that treatment intensification at late stages of therapy did not lead to an appreciable reduction of the tumor clone. The MRD status is to be evaluated at later stages of therapy, during week 52.
The aim of this study was to evaluate the results of combined application of tyrosine kinase inhibitors and chemotherapy in patients with Philadelphia chromosomepositive acute lymphoblastic leukemia. In this study, except Hematological Research Center in Moscow, participated 5 more hematological centers (Saint-Petersburg, Tula, Nizhny Novgorod, Irkutsk, Surgut). Results of the induction and postremission therapy proved to be very optimistic. However, there was a high toxicity and low reproducibility of treatment program that formed the basis for creating a new protocol of treatment for patients with Philadelphia chromosome-positive acute lymphoblastic leukemia in different age groups.