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Optimal use of MRD in adult patients with ALL: Recommendations from US experts
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In patients with ALL, MRD has been shown to be a strong prognostic factor across all subtypes and may be the most substantial contributor to the overall risk of relapse.1 However, the optimal timing and method to assess MRD, and the impact of MRD on treatment decisions, remain less clear.1 A panel of 10 experts from the US critically evaluated the optimal use of MRD in adult patients with ALL.1 Their recommendations were published in Blood Advances by Short et al.1 |
| Key learnings |
| When using MRD to guide treatment decisions, it is important to remember that the prognostic implications are context-dependent, influenced by the assay used and its sensitivity/specificity, timing of assessment, and disease-related features. |
| NGS-based MRD assays are preferred for B-ALL and can be complementary in T-ALL, though they are less validated in T-ALL. MFC and PCR-based assays may be helpful when NGS is unavailable or too expensive or when a rapid TAT is needed. |
| For patients with BM involvement, MRD monitoring using BM samples is recommended until MRD negativity is confirmed, after which PB evaluations using a high-sensitivity NGS-based MRD assay can serve as a less invasive option. |
| MRD status plays a pivotal role in guiding clinical decisions, including patient selection for MRD-directed therapies or allo-HSCT, thereby potentially improving outcomes, particularly in higher-risk populations. Careful interpretation is needed for low-level MRD results, especially in T-cell ALL, to avoid unnecessary treatment. |
Abbreviations: ALL, acute lymphoblastic leukemia; allo-HSCT, allogeneic hematopoietic stem cell transplantation; B-ALL, B-cell lineage ALL; BM, bone marrow; MFC, multiparameter flow cytometry; NGS, next-generation sequencing; PB, peripheral blood; PCR, polymerase chain reaction; T-ALL, T-cell lineage ALL; TAT, turnaround time.
References
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