Minimum Residual Disease in ALL

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Minimum residual disease (MRD) is an important prognostic marker for outcomes in patients with acute lymphoblastic leukemia (ALL), explains Jeffrey Lancet, MD. Achieving MRD-negativity has quickly become a key endpoint in clinical trials, since MRD is commonly considered a leading cause of relapse in patients with ALL.

Current methodologies to detect MRD include flow cytometry, immunoglobulin heavy chain rearrangements, and polymerase chain reaction assays, but it remains unclear which is the most effective test. MRD testing can help guide treatment selection, since it could predict response to therapy and early relapse.

Novel agents, such as the CD19-directed antibody blinatumomab, have successfully converted patients with MRD-positive disease to MRD-negative, explains Raoul Tibes, MD. In a phase II study presented at the 2014 ASH Annual Meeting, approximately 80% of patients treated with blinatumomab experienced a complete MRD response by polymerase chain reaction.

MRD can be utilized by practitioners to measure response and the likelihood of relapse, suggests Mark R. Litzow, MD. Multiparametric flow cytometry can effectively be utilized to detect MRD.