Minimal Residual Disease Assessment and Risk-based Therapy in Acute Lymphoblastic Leukemia

Publication date: July 2017 Source:Clinical Lymphoma Myeloma and Leukemia, Volume 17, Supplement Author(s): Renato Bassan, Tamara Intermesoli, Annamaria Scattolin, Piera Viero, Elena Maino, Rosaria Sancetta, Francesca Carobolante, Francesca Gianni, Paola Stefanoni, Manuela Tosi, Orietta Spinelli, Alessandro Rambaldi The study of minimal residual disease (MRD) in adult patients with acute lymphoblastic leukemia (ALL) allows a greater refinement of the individual risk classification and is the best support for risk-specific therapy with or without allogeneic hematopoietic cell transplantation (HCT). Using case-specific sensitive molecular probes or multiparametric flow cytometry on marrow samples obtained from the end of induction until midconsolidation, MRD assays can detect up to 1 leukemic cell of 10,000 total mononuclear cells (sensitivity, 0.01%; ie, ≥104). This cutoff, presently bound to technical limitations and subject to improvement, reflects the individual chemosensitivity and is strongly correlated with treatment outcome. The chance for cure is approximately 70% in the MRD-negative subset but only 20% to 30% in MRD-positive patients, in any diagnostic and risk subset. As shown by prospective trials from Germany, Italy, Spain, and France-Switzerland-Belgium, approximately 50% to 70% of unselected adult patients with Philadelphia-negative ALL achieve and maintain an early MRD response, whereas the remainder do not, including a substantial proportion of...
Source: Clinical Lymphoma Myeloma and Leukemia - Category: Cancer & Oncology Source Type: research