2021 ASCO Virtual Meeting: Leukemia TALK - Episode 5

MRD as a Prognostic Indicator in Children and Young Adults with Very High-Risk ALL

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Doug Smith, MD, provides context for the AALL1131: a phase III randomized trial for newly diagnosed high risk b-precursor acute lymphoblastic leukemia (ALL).

Data from the following presentations are discussed:

  • Minimal residual disease at end of induction and consolidation remain important prognostic indicators for newly diagnosed children and young adults with very high-risk (VHR) B-lymphoblastic leukemia (B-ALL): Children’s Oncology Group AALL1131. (Salzer, ASCO 2021 Abstract 10004)
    • Efficacy: Minimal residual disease (MRD) was examined in children and young adults with very high risk (VHR) B-acute lymphoblastic leukemia (B-ALL). Post-Induction therapy using fractionated cyclophosphamide and etoposide demonstrated significantly improved disease-free survival (DFS) (P =0.0013), in MRD positive and end of consolidation (EOC)MRD negative patients compared to EOC MRD positive patients. A greater 4-year disease-free survival was noted in EOI (end of induction) MRD <0.01%, (n = 325) compared to EOI MRD >0.01 (83.3% ± 2.6% vs 72.0% ± 2.8%, respectively).
    • Safety: Experimental arm 2 (cyclophosphamide, etoposide, and clofarabine treatment) was discontinued in September 2014 due to disproportionate toxicities.