The following
hypothetical case
studies may be similar
to patients who present
in your practice.
Explore
below to learn more.
Meet Lauren
A female patient with Ph(–) B-cell precursor acute lymphoblastic leukemia (ALL) who achieved complete remission (CR) and subsequently tested MRD(–) after frontline induction therapy
A female patient with Ph(–) B-cell
precursor
acute lymphoblastic leukemia
(ALL) who achieved complete remission (CR)
and
subsequently tested MRD(–) after frontline induction therapy
MRD snapshot
35% peripheral blasts
< 0.01% blasts
Name: Lauren K.
Age: 47
Sex: Female
Diagnosis: Ph(–) B-cell precursor ALL
Cytogenetics: Hyperdiploidy (> 50 chromosomes)
Considering your patient has received an MRD(–) result after CR, what may be your approach to monitoring this patient and determining the next course of treatment?
Evaluate the patient for signs and symptoms of relapse at her scheduled appointments
Monitor the patient by testing for MRD at the end of consolidation and every 3–6 months during post-consolidation surveillance
Meet Mateo
A male patient with Ph(+) B-cell precursor acute lymphoblastic leukemia (ALL) in complete remission (CR) who tested MRD(+) after frontline induction therapy
A male patient with Ph(+) B-cell precursor acute lymphoblastic leukemia (ALL) in complete remission (CR) who tested MRD(+) after frontline induction therapy
MRD snapshot
55% peripheral blasts
0.15% blasts
Name: Mateo R.
Age: 74
Sex: Male
Diagnosis: Ph(+) B-cell precursor ALL
Cytogenetics: t(9;22) BCR-ABL
After this patient tested MRD(+) following frontline induction therapy, what would your next steps be?
Rechallenge with
the same induction
regimen
Consider alternative
treatment
options (eg, alternative mechanism of action)
Meet Oliver
A male patient with Ph(–) B-cell precursor acute lymphoblastic leukemia (ALL) in first relapse who achieved complete remission (CR) following reinduction therapy but remains MRD(+)
A male patient with Ph(–) B-cell precursor acute lymphoblastic leukemia (ALL) in first relapse who achieved complete remission (CR) following reinduction therapy but remains MRD(+)
MRD snapshot
60% peripheral blasts
0.2% blasts
Name: Oliver S.
Age: 8
Sex: Male
Diagnosis: Ph(–) B-cell precursor ALL in first relapse
Cytogenetics: No chromosomal or molecular abnormalities
After this patient tested MRD(+) following reinduction therapy, what would your
approach
be as the next step in the patient’s treatment
journey?
Continue with the reinduction regimen for consolidation therapy
Consider alternative treatment options (eg, alternative mechanism of action) prior to HSCT
ALL, acute lymphoblastic leukemia; CR, complete remission; HSCT, allogeneic hematopoietic stem cell transplantation; MRD, measurable residual disease; NCCN, National Comprehensive Cancer Network; Ph(–), Philadelphia chromosome–negative; Ph(+), Philadelphia chromosome–positive.
References: 1. Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Acute Lymphoblastic Leukemia V.1.2022. ©National Comprehensive Cancer Network, Inc. 2022. All rights reserved. Accessed April 26, 2022. To view the most recent and complete version of the guideline, go online to NCCN.org. NCCN makes no warranties of any kind whatsoever regarding their content, use or application and disclaims any responsibility for their application or use in any way. 2. Dalle IA, Jabbour E, Short NJ. Evaluation and management of measurable residual disease in acute lymphoblastic leukemia. Ther Adv Hematol. 2020;11:2040620720910023. 3. Berry DA, Zhou S, Higley H, et al. Association of minimal residual disease with clinical outcome in pediatric and adult acute lymphoblastic leukemia: a meta-analysis. JAMA Oncol. 2017;3:e170580. 4. Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Pediatric Acute Lymphoblastic Leukemia V.1.2022.© National Comprehensive Cancer Network, Inc. 2021. All rights reserved. Accessed April 26, 2022. To view the most recent and complete version of the guideline, go online to NCCN.org. NCCN makes no warranties of any kind whatsoever regarding their content, use or application and disclaims any responsibility for their application or use in any way.