{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T09:13:25Z","timestamp":1788513205926,"version":"build-2803163510"},"reference-count":16,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T00:00:00Z","timestamp":1779062400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T00:00:00Z","timestamp":1779062400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100012166","name":"National Key Research and Development Program of China","doi-asserted-by":"publisher","award":["2023YFC2706301"],"award-info":[{"award-number":["2023YFC2706301"]}],"id":[{"id":"10.13039\/501100012166","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["European J of Haematology"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To determine whether early dexamethasone response provides complementary prognostic information to minimal residual disease (MRD) and whether integrating both markers refines risk stratification in pediatric acute lymphoblastic leukemia (ALL).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively analyzed pediatric ALL patients treated at a single center according to the CCCG\u2010ALL\u20102015 protocol. Day 5 steroid response was classified as dexamethasone good response (DGR) or dexamethasone poor response (DPR). Bone marrow MRD was measured on Days 19 and 46 of induction. A four\u2010quadrant classification was constructed by combining Day 5 steroid response with Day 46 MRD status (DGR\/MRD\u2212, DGR\/MRD+, DPR\/MRD\u2212, DPR\/MRD+) to evaluate event\u2010free survival (EFS) and cumulative incidence of relapse (CIR).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 312 patients, 220 were DGR and 92 were DPR. MRD negativity rates on Days 19 and 46 were significantly lower in DPR. Among 304 patients with paired MRD measurements, 181, 102, 18, and 3 patients were classified as D19\u2212\/D46\u2212, D19+\/D46\u2212, D19+\/D46+, and D19\u2212\/D46+, respectively, with progressively worse 5\u2010year EFS and increasing 5\u2010year CIR. In the four\u2010quadrant analysis, EFS differed significantly across groups, and compared with DGR\/MRD\u2212, the other quadrants exhibited higher event risk. In multivariable Cox models, Day 46 MRD remained independently associated with inferior EFS (HR\u2009=\u20092.429, 95% CI: 1.286\u20134.590;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.006). When the four\u2010quadrant classification was entered into the multivariable model (reference: DGR\/MRD\u2212), DGR\/MRD+ (HR\u2009=\u20094.319, 95% CI 1.792\u201310.414;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001), DPR\/MRD\u2212 (HR\u2009=\u20092.207, 95% CI: 1.253\u20133.888;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.006), and DPR\/MRD+ (HR\u2009=\u20093.718, 95% CI: 1.608\u20138.598;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002) were each associated with increased event risk.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>MRD kinetics identify patients with delayed clearance or persistent positivity at higher relapse risk. Integrating early steroid response with MRD using a four\u2010quadrant framework may complement MRD\u2010based assessment and further refine risk stratification by highlighting clinically meaningful discordant subgroups.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ejh.70222","type":"journal-article","created":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T23:19:38Z","timestamp":1779146378000},"page":"966-972","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Combined Early Steroid Response and\n                    <scp>MRD<\/scp>\n                    Improve Risk Stratification in Pediatric Acute Lymphoblastic Leukemia: The\n                    <scp>CCCG<\/scp>\n                    \u2010\n                    <scp>ALL<\/scp>\n                    \u20102015 Study"],"prefix":"10.1111","volume":"117","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9929-5619","authenticated-orcid":false,"given":"Wenxin","family":"Ou","sequence":"first","affiliation":[{"name":"Department of Hematology and Oncology National Children's Medical Center, Children's Hospital of Fudan University  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Hematology and Oncology National Children's Medical Center, Children's Hospital of Fudan University  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaohua","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Hematology and Oncology National Children's Medical Center, Children's Hospital of Fudan University  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junye","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of Hematology and Oncology National Children's Medical Center, Children's Hospital of Fudan University  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ping","family":"Cao","sequence":"additional","affiliation":[{"name":"Department of Hematology and Oncology National Children's Medical Center, Children's Hospital of Fudan University  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianhua","family":"Meng","sequence":"additional","affiliation":[{"name":"Department of Hematology and Oncology National Children's Medical Center, Children's Hospital of Fudan University  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Le","sequence":"additional","affiliation":[{"name":"Department of Hematology and Oncology National Children's Medical Center, Children's Hospital of Fudan University  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0378-2410","authenticated-orcid":false,"given":"Yang","family":"Fu","sequence":"additional","affiliation":[{"name":"Department of Hematology and Oncology National Children's Medical Center, Children's Hospital of Fudan University  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9409-3452","authenticated-orcid":false,"given":"Zifeng","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Hematology and Oncology National Children's Medical Center, Children's Hospital of Fudan University  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie","family":"Man","sequence":"additional","affiliation":[{"name":"Department of Hematology and Oncology National Children's Medical Center, Children's Hospital of Fudan University  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhiyi","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Hematology and Oncology National Children's Medical Center, Children's Hospital of Fudan University  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maoxiang","family":"Qian","sequence":"additional","affiliation":[{"name":"Shanghai Key Laboratory of Birth Defects, Children's Hospital of Fudan University, National Children's Medical Center, and Shanghai Key Laboratory of Medical Epigenetics, International Co\u2010Laboratory of Medical Epigenetics and Metabolism (Ministry of Science and Technology) Institutes of Biomedical Sciences, Fudan University  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongsheng","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Hematology and Oncology National Children's Medical Center, Children's Hospital of Fudan University  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3505-0302","authenticated-orcid":false,"given":"Xiaowen","family":"Zhai","sequence":"additional","affiliation":[{"name":"Department of Hematology and Oncology National Children's Medical Center, Children's Hospital of Fudan University  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,18]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11864-024-01237-w"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.molmed.2025.04.005"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1038\/leu.2016.234"},{"issue":"7","key":"e_1_2_13_5_1","article-title":"Ex Vivo Drug Responses and Molecular Profiles of 597 Pediatric Acute Lymphoblastic Leukemia Patients","volume":"9","author":"Enblad A. 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