SOHO 2025 | The current role of MRD in ALL subtypes
In this video, Nicholas Short, MD, The University of Texas MD Anderson Cancer Center, Houston, TX, discusses the evolving role of measurable residual disease (MRD) in subtypes of acute lymphoblastic leukemia (ALL). Dr Short outlines the techniques being used to measure MRD in Philadelphia chromosome (Ph)-positive and Ph-negative ALL, as well as in T-cell ALL, and highlights its role in risk stratification and treatment selection. This interview took place at the 13th Annual Meeting of the Society of Hematologic Oncology (SOHO 2025) in Houston, TX.
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Transcript
So we had three excellent talks in the ALL MRD session, one on Philadelphia chromosome positive ALL, one on Philadelphia chromosome negative B-cell ALL, and one on T-cell ALL. So I think in Ph-positive ALL, I think the main takeaway is that we’re really appreciating the role of the MRD for immunoglobulin receptor or T-cell gene rearrangements rather than reliance on PCR for BCR-ABL...
So we had three excellent talks in the ALL MRD session, one on Philadelphia chromosome positive ALL, one on Philadelphia chromosome negative B-cell ALL, and one on T-cell ALL. So I think in Ph-positive ALL, I think the main takeaway is that we’re really appreciating the role of the MRD for immunoglobulin receptor or T-cell gene rearrangements rather than reliance on PCR for BCR-ABL. We know that about 20 to 25% of patients will have multi-lineage Ph-positive ALL, and in those patients, PCR for BCR-ABL is not an optimal way of measuring MRD. So I think there’s general movement away from PCR for BCR-ABL and more towards, at least in the US, NGS-based MRD for these immunoglobulin gene rearrangements.
In Ph-negative B-cell ALL, this NGS MRD is also extremely important. I think we’re getting emerging data about the importance of early dynamics of MRD in these patients, particularly for high-risk patients. And so we’re using this to risk stratify patients. So for example, in Ph-negative B-cell ALL, if a patient has high-risk genomic features, there’s emerging data that if they achieve early rapid NGS MRD clearance, those patients can actually have favorable outcomes and we may not necessarily need to transplant them. However, patients who have Philadelphia-chromosome negative B-cell ALL who have suboptimal MRD clearance, those patients need to be referred for CAR T-cell therapy or for potentially stem cell transplant.
Now, in T-cell ALL, we have less data on the NGS MRD assay, but I think the early data suggests that this is likely to be a very important tool in terms of assessing MRD for these patients. So we await more clinical data. For now, it’s a combination of flow cytometry as well as NGS-based MRD. And we really need some more clinical validation studies, but I think in the future we will be relying on NGS-based MRD for most patients with T-cell ALL, at least as long as they calibrate on the assay. If they don’t, then we’ll rely on flow cytometry.
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