End-of-induction MRD predicts poorer survival in childhood ALL in Eastern India

Children with acute lymphoblastic leukemia whose measurable residual disease remained detectable at the end of induction chemotherapy had markedly worse survival outcomes, according to a retrospective cohort study conducted at a single center in Eastern India. Among 247 children assessed, the 27 patients with positive end-of-induction MRD showed a five-year event-free survival of 52.6 percent compared with 73.9 percent in MRD-negative patients, and five-year overall survival of 63.1 percent versus 81.6 percent, with relapse rates of 37.0 percent versus 15.9 percent respectively.

The study, published in BMC Cancer, included 262 children with ALL treated between January 2016 and December 2025 using a modified ALL BFM-IC 2002 protocol. Of these, 247 underwent end-of-induction MRD assessment; 13 died during induction chemotherapy and 2 had induction failure. MRD was measured by multiparameter flow cytometry with a sensitivity of 0.01 percent, and survival analysis was performed using the Kaplan–Meier method, while logistic regression identified predictors of MRD positivity.

MRD positivity was detected in 27 patients, representing 10.9 percent of those assessed, and was significantly associated with several baseline characteristics: older age above 10 years (p = 0.038), T-cell immunophenotype (p = 0.005), NCI high-risk disease (p = 0.038), and BFM high-risk stratification (p = 0.016). T-cell immunophenotype showed the strongest association with end-of-induction MRD positivity, with an odds ratio of 3.73 (95 percent CI 1.57–8.87; p = 0.003).

At a median follow-up of 36 months, the estimated five-year event-free survival for the whole cohort was 71.5 percent and overall survival was 78.7 percent. The authors report that these findings are consistent with previously published studies and further confirm the prognostic importance of end-of-induction MRD in children with ALL treated in a low- and middle-income country, where robust outcome data have remained limited.

Based on their results, the researchers conclude that MRD-guided risk stratification should be routinely incorporated into pediatric ALL management. As a retrospective single-center analysis, the study reflects outcomes from one Eastern Indian center using a specific treatment protocol and flow cytometry sensitivity of 0.01 percent, and the reported associations describe prognosis rather than effects of any intervention.

Subject of Research: Prognostic value of end-of-induction measurable residual disease in childhood acute lymphoblastic leukemia

Article Title: Prognostic significance of end-of-induction measurable residual disease in childhood acute lymphoblastic leukemia: a retrospective cohort study from Eastern India

Article References: Panda, S. P., Pradhan, S., Prusty, J. B. K., Mishra, S., Samantray, L., & Panda, S. S. (2026). Prognostic significance of end-of-induction measurable residual disease in childhood acute lymphoblastic leukemia: a retrospective cohort study from Eastern India. BMC Cancer. https://doi.org/10.1186/s12885-026-17218-1

Image Credits: AI Generated

DOI: 10.1186/s12885-026-17218-1

Keywords: childhood ALL, measurable residual disease, end-of-induction MRD, event-free survival, overall survival, flow cytometry, risk stratification, pediatric oncology, India, retrospective cohort, BFM protocol, T-cell immunophenotype