Minimal residual disease in acute lymphoblastic leukaemia


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Nick Goulden

Royal Hospital for Children and University of Bristol, UK

Abstract

It is now 20 years since the first descriptions of techniques capable of sensitive detection of minimal residual disease (MRD) in acute lymphoblastic leukaemia (ALL).

At the time it was hoped that measurement of MRD would allow much more accurate stratification of relapse risk than conventional prognostic factors such as age, presenting white cell count, leukaemia cytogenetics and morphologic assessment of early response to therapy. However, early optimism was dashed by design flaws in retrospective studies and concerns over clonal stability. Gradually these problems have been overcome by innovation and the study of large homogeneous cohorts of patients with prolonged follow-up. Indeed it is now clear that MRD status is now the most important prognostic factor in children with ALL receiving identical therapy.

This presentation will use examples from the current UK frontline and relapse studies to illustrate the utility of MRD measurement in modern ALL protocols. It will demonstrate how the technology can be used to highlight a large cohort of children at very low risk of relapse who are candidates for a reduction in therapy. In addition MRD based strategies for optimising the outcome of the most intensive therapy, allogeneic stem cell transplant, will be discussed.