Leukemia and Lymphoma: Detection of Minimal Residual Disease
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You cannot use genetic mutations to monitor MRD in patients treated with anything that induces differentiation—such as all-trans retinoic acid and IDH2 inhibitors, at least not early on in the treatment. If a cell differentiates, it does not die right away; the genetic variant persists.
This is relevant for clinical trial design. Most experts say that if you are evaluating a new treatment, you have to establish the clinically relevant threshold of MRD retrospectively in the first trial; then you can apply it prospectively. We still have to look for those patients who are MRD-negative and who relapse and then find out why they relapsed. The results can be hugely variable. You have to be careful, because measuring MRD and not really knowing what you are doing is worse than not measuring it at all.
New Molecular Technologies for Minimal Residual Disease Evaluation in B-Cell Lymphoid Malignancies
If you get a false-positive or a false-negative result, you may harm the patient. Again, one of the good points about the European LeukemiaNet paper is that the group is trying to establish standards for testing. Testing should not be done by a community laboratory unless the staff have been trained by experts.
The European LeukemiaNet Working Party, in its report, clearly says that samples should be sent to a central lab. Even in ALL, the testing situation is not ideal. You have no idea how often I receive e-mails from pathology labs who have questionable findings.
I am fortunate to be able to discuss disparate results with an expert at the COG to arbitrate them. My suggestion is that oncologists who want to test for MRD should either put these patients on clinical trials, where there are central laboratories to do the testing, or send samples to reputable commercial laboratories that use the COG approach. They definitely should get help with interpretation, which is the most critical factor. Sub-Investigator: Nancy Bartlett, M. Sub-Investigator: Todd Fehniger, M. Sub-Investigator: Amanda Cashen, M.
Sub-Investigator: Brad Kahl, M. Washington University School of Medicine. More Information. Additional Information: Alvin J.
National Library of Medicine U. National Institutes of Health U. Department of Health and Human Services. The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Peripheral T Cell Lymphoma.
Leukemia and Lymphoma
Study Type :. Estimated Enrollment :.
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Actual Study Start Date :. Estimated Primary Completion Date :. Estimated Study Completion Date :. Arm 1: Lymphotrack -Patients will be treated with frontline chemotherapy per the treating physician's discretion. This specimen should have a high disease load Procedure: Peripheral blood draw -Baseline, C1D1, C1D8, C1D15, C2D1, C3D1, C4D1, C5D1, C6D1, end of treatment, 3 month follow-up optional , 6 month follow-up, 9 month follow-up optional , 12 month follow-up, 15 month follow-up optional , 18 month follow-up, 21 month follow-up optional , 24 month follow-up, and at relapse Procedure: Lymphotrack TCR clonality assay -Assay with high sensitivity that can be performed with peripheral blood.
Contact: Eric D Jacobsen, M. Clinical importance of minimal residual disease in childhood acute lymphoblastic leukemia. Blood ; Clinical significance of minimal residual disease in childhood acute lymphoblastic leukemia and its relationship to other prognostic factors: A Children's Oncology Group study.
Prognostic significance and modalities of flow cytometric minimal residual disease detection in childhood acute lymphoblastic leukemia. Kirkup L.
Campana D, Coustan-Smith E. Advances in the immunological monitoring of childhood acute lymphoblastic leukaemia. Best Pract Res Clin Haematol ; Methodological approach to minimal residual disease detection by flow cytometry in adult B-lineage acute lymphoblastic leukemia. Haematologica ; Taylor J. Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc ; Al-Eid H, Areth S. Cancer Incidence Report Saudi Arabia Kingdom of Saudi Arabia. Ministry of Health.
National Cancer Registry; Rabin KR.