Measurable Residual Disease in Acute Lymphoblastic Leukemia: Optimization and Innovation in 2021 and Beyond

Abstract

Introduction Measurable residual disease (MRD) is an established component of acute lymphoblastic leukemia (ALL) management in both children and adults. Society guidelines and expert consensus documents include assessment of MRD as the standard of care following induction therapy, consolidation therapy, and at additional time points, depending on the treatment regimen administered.1–3 Further, the approval of blinatumomab for MRD+ B-ALL has advanced the concept of MRD response as a clinical endpoint in ALL. Although the utility of MRD in ALL has been well defined over the last decades, several questions remain. This extended abstract and the associated presentation focus on areas of ongoing controversy and exploration in ALL MRD, including the following.1) Does increasing the depth of MRD assessment add prognostic value? 2) Is there a role for ongoing MRD monitoring once patients achieve MRD– response? 3) Can MRD assessment of the peripheral blood be substituted for bone marrow? 4) Should MRD assays be applied to the analysis of the central nervous system (CNS)? Measurable residual disease (MRD) is an established component of acute lymphoblastic leukemia (ALL) management in both children and adults. Society guidelines and expert consensus documents include assessment of MRD as the standard of care following induction therapy, consolidation therapy, and at additional time points, depending on the treatment regimen administered.1–3 Further, the approval of blinatumomab for MRD+ B-ALL has advanced the concept of MRD response as a clinical endpoint in ALL. Although the utility of MRD in ALL has been well defined over the last decades, several questions remain. This extended abstract and the associated presentation focus on areas of ongoing controversy and exploration in ALL MRD, including the following.1) Does increasing the depth of MRD assessment add prognostic value? 2) Is there a role for ongoing MRD monitoring once patients achieve MRD– response? 3) Can MRD assessment of the peripheral blood be substituted for bone marrow? 4) Should MRD assays be applied to the analysis of the central nervous system (CNS)?