BSH 2019 | MRD in pediatric ALL: clinical evidence, treatment decisions & outcomes

(MRD) It’s the most reliable indicator we have of what the outcomes will be in children. We’re just starting on treatment and it’s also one of the markers that we now use to identify children with increased bulk of residual disease not responding to the initial treatment. Many of these patients will benefit from intensification after that phase.

MRD changes the outcomes of patients in two ways, we know that ALL is a heterogeneous disease, some patients are very chemo sensitive and require much less treatment. Some people, some children have more chemo resistant disease and benefit from more intensive treatment, all the way to some patients actually benefiting from transplantation. By using MRD we can identify patients, give them much less intensified treatment, less times in hospital, less toxicities and a much better quality of life and identify the really high risk patients who will benefit, not only from more intensified therapy, but transplantation and this era now from novel targeted therapy, before the disease actually comes back.

MRD alone isn’t enough so the first question you’ve got really is: that you treat a child, or a patient, and then you measure the disease, and then he said okay they didn’t respond as well as we would have liked them to do, but can you predict that from the beginning in which case you could come in with more correct chemotherapy right from the beginning. So what determines this MRD? We have some clues, we know that all the children are more likely to be MRD positive, so age is a factor but we think more likely the genetics of the leukemia itself is actually determining what this MRD is and what this residual disease is. So therefore, newer therapies that target these genetic changes may also be effective