- 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.
- 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.