Sarah K. Tasian, MD, an attending physician and assistant professor of pediatrics in the Division of Oncology at Children’s Hospital of Philadelphia, discusses genetic testing in pediatric acute lymphoblastic leukemia (ALL).
A complicated tiered genetic testing algorithm is used in children, different than what is used in adults, Tasian explains. All patients with high-risk ALL being treated on frontline Children’s Oncology Group phase III trials undergo this testing. Each newly-diagnosed patient is tested with a gene expressing screening called a low-density microarray, which identifies patients who do not have Philadelphia chromosome (Ph)-like ALL. If the patient does not have Ph-like ALL, they do not need to undergo further testing.
Identifying patients who have Ph-like ALL through the low-density microarray aids in arranging the downstream molecular testing. Tasian says that the most commonly used tests are fusion-based platforms like the Archer next-generation sequencing test. This helps identify which kinase fusions patients have, which can point to what tyrosine kinase inhibitor to give, or what clinical trial to enroll the patient in.