EHA 2026 | MRD assessment and biologic risk stratification shape personalized care in ALL

I think, you know, one of the challenges with acute lymphoblastic leukemia (ALL) is that we now have increasing tools in our toolkit, good problem to have, different drugs, both improvements in our understanding of how to use conventional chemotherapy, targeted therapy now, BCR-ABL kinase inhibitors, immunotherapy, ongoing research rapidly, you know, every couple of years, how we use these drugs is changing in terms of the standard. And then we’re always pushing the envelope in terms of how to use these drugs even better. At the same time, we have a more sophisticated understanding of the biologic subgroups, primarily understood based on their different genomics. And so we have now a different understanding of different genomic subtypes. And then we have a better ability also to detect residual disease at very low levels. So we have all these different parameters now of treatment, subtypes, and minimal residual disease (MRD). And we’re trying to understand how to use all that information. And so we have to test different new therapies in different subgroups and figure out for whom the best combination of drugs and understand responses in those subgroups and make different developments and best practices for each of those subgroups. It’s a challenge because this is not a super common disease. And so we have to be very strategic about those, about how we test and monitor for response. And that’s where MRD assays, I think, can really come in. Of course, they’re surrogate assays, and the most important thing for our patients is that the disease doesn’t relapse and that they live a long time. But studies, those readouts, while very important, and I do emphasize that we should be following all these patients on clinical trials for as long as possible, very important to do that follow-up and report those late outcomes. But at the same time, having an early readout can be really informative to understand how sensitive diseases are to these various therapies. And that’s where MRD, including novel next-generation sequencing (NGS), sensitive MRD assessments are really important. And then that gives us an early sense of response to these treatments and that allows us to continue to study, which is where we are actively studying, how well do those MRD responses predict the late outcomes in each of these treatment settings? Because if we can establish that, then we know how to use those drugs and assays to then modify the second phase of treatment, the consolidation. Can we do treatment de-escalation? Who can benefit from de-escalation? Who do we need to discuss treatment escalation and further refine those therapies? So MRD is an important tool in our toolkit. We need to continue to study, use it to study our therapies and continue to study the assays themselves in terms of their performance in determining long-term outcomes. So lots of progress, which is a great problem to have. Great to be at meetings where we discuss that and celebrate that. But lots of work to be done for all the current investigators and future investigators in the field.

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