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MRD Monitoring in Acute Lymphoblastic Leukemia

Insights From:Stefan Faderl, MD, John Theurer Cancer Center; Raoul Tibes, MD, PhD, Mayo Clinic; Bijal D. Shah, MD, Moffitt Cancer Center
Published: Thursday, Apr 07, 2016


Transcript:

Raoul Tibes MD, PhD:
Fortunately, over the last several decades, our chemotherapeutic regimens have greatly improved, and we can get most patients into remission now. The remission rates with most of those cytotoxic regimens are high in the range of 90% -95% or even higher. The problem for ALL is the relapse rates are also very high. So how can we improve on the initial excellent responses and complete remissions? One option is to pursue an allogeneic stem cell transplantation if a patient qualifies, has a suitable donor available, and if the patient wants to receive a transplant because it’s a very involved procedure. I would recommend to refer all adult patients who are potentially eligible, those who are in remission or who are undergoing their initial ALL treatment, to a transplant center at least for consultation.

With the development of MRD, or minimal residual disease monitoring, we now have the ability to detect very few cells at the MRD level after chemotherapy. Even if a patient has received a complete remission, there may be a low level burden of ALL cells still around in the blood or bone marrow that we can now measure with some of the techniques I mentioned earlier. This will help us more and more to risk stratify patients to appropriate treatments after the initial induction. For high-risk disease where there’s a significant burden or significant MRD present, patients should proceed to allogeneic stem cell transplantation. Whether patients should receive additional treatment before the transplant - is an ongoing question- but I would say most likely at this point or definitely at this point.

We’re not just talking about frank morphological relapse when you can see blasts in the blood or bone marrow, we’re now talking about molecular relapse based on MRD monitoring. This will help us stratify our patients more and more in different risk groups. As I mentioned earlier, the persistent MRD after induction is one of the most important prognostic parameters for all adult patients with ALL that helps us stratify their next treatment steps.

Transcript Edited for Clarity
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Transcript:

Raoul Tibes MD, PhD:
Fortunately, over the last several decades, our chemotherapeutic regimens have greatly improved, and we can get most patients into remission now. The remission rates with most of those cytotoxic regimens are high in the range of 90% -95% or even higher. The problem for ALL is the relapse rates are also very high. So how can we improve on the initial excellent responses and complete remissions? One option is to pursue an allogeneic stem cell transplantation if a patient qualifies, has a suitable donor available, and if the patient wants to receive a transplant because it’s a very involved procedure. I would recommend to refer all adult patients who are potentially eligible, those who are in remission or who are undergoing their initial ALL treatment, to a transplant center at least for consultation.

With the development of MRD, or minimal residual disease monitoring, we now have the ability to detect very few cells at the MRD level after chemotherapy. Even if a patient has received a complete remission, there may be a low level burden of ALL cells still around in the blood or bone marrow that we can now measure with some of the techniques I mentioned earlier. This will help us more and more to risk stratify patients to appropriate treatments after the initial induction. For high-risk disease where there’s a significant burden or significant MRD present, patients should proceed to allogeneic stem cell transplantation. Whether patients should receive additional treatment before the transplant - is an ongoing question- but I would say most likely at this point or definitely at this point.

We’re not just talking about frank morphological relapse when you can see blasts in the blood or bone marrow, we’re now talking about molecular relapse based on MRD monitoring. This will help us stratify our patients more and more in different risk groups. As I mentioned earlier, the persistent MRD after induction is one of the most important prognostic parameters for all adult patients with ALL that helps us stratify their next treatment steps.

Transcript Edited for Clarity
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