Post-Induction Minimal Residual Disease Study by Flow Cytometry in Pediatric B ALL and Its Correlation with Initial Clinical and Laboratory Parameters
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Keywords
B-cell acute lymphoblastic leukemia, minimal residual disease, pediatric leukemia, flow cytometry
Abstract
Background: Acute lymphoblastic leukemia (ALL) is a cancer characterized by the rapid and uncontrolled growth of immature lymphoid cells. Among its subtypes, B-lineage ALL in children represents the most frequently diagnosed malignancy in the pediatric population. Despite high survival rates, relapsed or refractory cases remain challenging. Minimal Residual Disease (MRD), detected by flow cytometry, is a strong prognostic marker that guides the intensity of post-induction therapy. Aim: This study aims to evaluate the correlation between post-induction MRD, measured by multicolor flow cytometry, and the initial clinical and laboratory parameters in pediatric patients with B-ALL. Methods: A retrospective cross-sectional study was conducted at the Children’s Specialty Hospital in Basrah, including 51 pediatric B-ALL patients (aged 1–14 years) treated between April 2023 and August 2024. All patients successfully completed the induction phase of chemotherapy, and their MRD status was subsequently evaluated. Results: MRD was negative in 60.78% and positive in 39.22% of patients. The majority of patients in both MRD groups were under 10 years old, with no significant age-related difference (P = 0.732). Patients with positive MRD had significantly higher mean white blood cell (WBC) counts (58.62 ± 86.9 vs. 11.44 ± 13.04) and blast cell percentages (87.1% ± 7.6% vs. 76.6% ± 16%) compared to those with negative MRD (P = 0.004 and 0.008, respectively). No significant associations were found between MRD and hemoglobin levels, platelet counts, or National Cancer Institute (NCI) risk classification. Conclusions: Flow cytometric MRD detection is a valuable prognostic tool in pediatric B-ALL. Higher WBC counts and blast percentages at presentation are associated with positive MRD, while MRD was not significantly linked to age, hemoglobin, platelet count, or risk stratification
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