Leukemic Cell Dynamics and Chemotherapy Responsiveness in Pediatric Acute Leukemia: Prognostic Significance for Treatment Outcomes

Abstract

Background: Dynamic evaluation of leukemic cell elimination and their sensitivity to cytostatic therapy is a critical area in pediatric hemato-oncology. Early assessment of treatment response may improve risk stratification and therapeutic outcomes.

Methods: Children newly diagnosed with acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML) were included. Bone marrow and peripheral blood parameters were monitored on days 8, 15, and 33 of induction therapy. Techniques employed included multicolor flow cytometry for minimal residual disease (MRD), quantitative PCR for chimeric gene expression, and cytomorphological analysis of bone marrow aspirates.

Results: Slow reduction kinetics of leukemic clones and persistence of high MRD levels after the first chemotherapy course correlated with increased relapse rates and reduced overall and event-free survival. Conversely, achievement of an early deep molecular response was associated with durable remission.

Conclusion: Dynamic monitoring of blast cell elimination represents a decisive independent prognostic criterion in pediatric acute leukemia. These findings justify timely adjustment of chemotherapy intensity and early introduction of targeted or immunotherapeutic agents in patients with delayed response to induction therapy.