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ESH AL 2018 | The importance of standardization in MRD testing

In this video, Oliver Ottmann, MD, FRCPath, of Cardiff University, Cardiff, UK, discusses the importance of allogeneic transplant in different populations of patients with Ph-positive acute lymphoblastic leukemia (ALL). From the 2018 European School of Hematology (ESH) Clinical Updates on Acute Leukemias, held in Budapest, Hungary, Prof. Ottmann also emphasizes the areas for improvement in measurable residual disease (MRD) testing.

Transcript (edited for clarity)

These debates are always intended to stimulate discussion and to maybe display a more pronounced version of what you really think, so I do believe that allogeneic transplant has a very clear role in treating Ph-positive ALL, including MRD negative patients, so that was not only the position I had to take but it is the position that I do have. However, we are not looking at a benign procedure; allogeneic transplant has a lot of problems, we have gotten much better than in the past, but it has a substantial morbidity and mortality impact on life, and that is related to patient age, so clearly one has to take into consideration these factors...

These debates are always intended to stimulate discussion and to maybe display a more pronounced version of what you really think, so I do believe that allogeneic transplant has a very clear role in treating Ph-positive ALL, including MRD negative patients, so that was not only the position I had to take but it is the position that I do have. However, we are not looking at a benign procedure; allogeneic transplant has a lot of problems, we have gotten much better than in the past, but it has a substantial morbidity and mortality impact on life, and that is related to patient age, so clearly one has to take into consideration these factors. So, what does the patient want, what can the patient tolerate? We can address some of these issues by changing or modifying the procedure, but clearly it is not something that is applicable to each and every patient. So that is one area where I think the debate suggested more of a difference than actually Farhad Ravandi and I have.
Farhad also pointed out an area which I omitted on purpose, and that is the pediatric population. It is becoming quite clear that the pediatric Ph-positive ALL is a different disease, we also all know elderly patients who actually have but done well over many years without transplant, and so I think those are patient populations where a comparison you know the pediatric, the elderly that do well, those that don’t well, can maybe yield insights into the biology to understand what is the prerequisite to actually cure somebody with kinase inhibitors without transplant.
I think both of us, Farhad and I, acknowledged and actually emphasized that minimal residual disease is in substantial need of standardization, harmonization, that the application of terminology, methodology, implementation in trials, and I don’t even want to think about their use outside of trials, is so heterogeneous that you cannot compare across studies. And that is something that has been addressed many years ago in the Philadelphia negative by the EuroMRD group, and we just actually yesterday submitted a paper which was the first attempt to harmonize MRD analysis in BCR-ABL positive ALL, and we are obviously hoping that it will be accepted because it would provide some guidance to harmonize across groups

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