AI Article Synopsis

  • Detection of measurable residual disease (MRD) is crucial for predicting relapse and guiding treatment in adults with acute lymphoblastic leukemia (ALL), with next-generation sequencing (NGS) providing better sensitivity than traditional methods.
  • This study compared MRD detection between NGS and flow cytometry (MFC) in 52 adult patients, finding that NGS was a more accurate predictor of relapse risk post-treatment.
  • Results indicated that NGS could identify patients at higher risk of relapse, especially those initially deemed MRD negative by MFC, highlighting its potential to optimize adjuvant therapy decisions.

Article Abstract

Introduction: Detection of measurable residual disease (MRD) in adults with acute lymphoblastic leukemia (ALL) is a vital biomarker in risk prediction and treatment selection. Next-generation sequencing (NGS) offers greater sensitivity relative to multiparametric flow cytometry (MFC) and may be a better predictive tool for identifying ALL patients at risk of relapse.

Patients And Methods: This single-center retrospective study compares MRD detection by NGS versus MFC in 52 adult B- and T-ALL patients treated at our institution between 2018 and 2023. Pretreatment bone marrow samples were used for assay calibration, while post-treatment MRD assessment was completed up to 4.5 months after the first complete remission (CR1) using an MRD cutoff of 10 for distinguishing relapse risk.

Results: The 2-year cumulative incidence of relapse (CIR) among patients who were MRD positive using MFC and NGS was 39.5% and 46.2%, respectively. Unlike MFC, post-CR1 MRD positivity with NGS significantly predicted CIR (HR = 9.47, P = .028). In patients who were MRD negative by MFC, low levels of MRD detected by NGS distinguished patients at high risk of relapse (HR 10.3, P = .026, 2-year CIR 51.6%).

Conclusion: Our data suggests that assessment of post-CR1 MRD using a highly sensitive NGS assay can identify ALL patients undergoing frontline therapy at increased risk of relapse and guide the use of adjuvant therapy.

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http://dx.doi.org/10.1016/j.clml.2023.11.002DOI Listing

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