Dr Park on the Role and Benefits of Evaluating MRD in ALL

“MRD is one of the single most important prognostic markers in ALL [management]. The good thing now is that there is a [FDA]-approved [MRD] assay that is widely available.”

Jae Park, MD, chief of the Cellular Therapy Service at Memorial Sloan Kettering Cancer Center, discussed the benefits of evaluating minimal residual disease (MRD) in acute lymphoblastic leukemia (ALL) and how the MRD testing and monitoring process often unfolds.

Park began by noting how he believes that all patients with ALL, especially those with B-cell disease subtypes, should undergo MRD assays. Park mentioned that the role of MRD in ALL is changing, now with specific therapies that are indicated for patients with MRD-positive disease. Park pointed to blinatumomab (Blincyto), adding that this treatment is indicated for both MRD-positive and MRD-negative ALL. However, there are available therapies that enable patients who have MRD-positive ALL to reach MRD negativity, he said.

Park underscored how monitoring MRD in patients with ALL is a dynamic process, especially in specific subsets of patients. Park designated one of these subsets as patients who are seeking bone marrow transplants, like patients with high-risk ALL or high-risk cytogenetics, since MRD negativity is favorable prior to the procedure. Park then weighed the numerous approaches these patients with high-risk disease can take in relation to MRD, outlining potential options like blinatumomab usage prior to bone marrow transplant to preserve MRD negativity, or CAR T-cell therapy as an alternative to transplant if MRD positivity persists.

Although evaluating MRD prior to bone marrow transplant is important for ALL management, Park also acknowledged the relevance of post-transplant MRD monitoring. TKI maintenance therapy, donor lymphocyte infusion, and blinatumomab following bone marrow transplant were all options that Park mentioned as important to consider. Park closed by stressing the significance of both pre- and post-bone marrow transplant MRD monitoring for patients with ALL.