ALL: guidelines for MRD assessment and management

  • Short NJ & al.
  • Am J Hematol
  • 5 Nov 2018

  • Oncology guidelines update
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Takeaway

  • A consensus of North American experts has published new recommendations for the assessment and management of minimal residual disease (MRD) in adults with acute lymphoblastic leukemia (ALL).

Why this matters

  • An increasing range of testing methods and the emergence of novel therapeutics with high-level efficacy in eradicating residual disease have advanced treatment but complicated decisions around MRD testing.

Key recommendations

  • MRD testing should generally be performed in bone marrow specimens for optimal sensitivity as detectable MRD in peripheral blood can be 1-3 logs lower.
  • Regardless of method, testing sensitivity of at least 10-4 is considered adequate.
  • Timing/regularity for MRD testing is clarified for various patient types, including:
    • Adults with ALL receiving first-line therapy.
    • Patients with Ph-positive ALL who did not undergo hematopoietic stem cell transplantation (HSCT) in first remission.
    • Patients planned for HSCT.
    • Patients receiving salvage therapy for relapsed/refractory ALL: MRD testing provides greater predictive value in patients in first salvage.
  • Treatment algorithms are provided guiding use of BCR-ABL1 tyrosine kinase inhibition and blinatumomab to optimize patients for planned allogeneic HSCT.
  • Funding: The PLATO Foundation.

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