Has MRD monitoring superseded other prognostic factors in adult ALL?
Cet article passe en revue les travaux récents sur l'intérêt d'évaluer la maladie résiduelle minimale pour le suivi de l'efficacité thérapeutique chez les adultes atteints d'une leucémie lymphoblastique aiguë
Significant improvements have been made in the treatment of acute lymphoblastic leukemia (ALL) during the past two decades, and measurement of submicroscopic (minimal) levels of residual disease (MRD) is increasingly used to monitor treatment efficacy. For a better comparability of MRD data there are ongoing efforts to standardize MRD quantification using real-time quantitative polymerase chain reaction (RQ-PCR) of clonal immunoglobulin and T-cell receptor gene rearrangements, RQ-PCR-based detection of fusion gene transcripts or breakpoints, and multiparameter flow cytometric immunophenotyping. Several studies have demonstrated that MRD assessment in childhood and adult ALL significantly correlates with clinical outcome. MRD detection is particularly useful for evaluation of treatment response, but also for early assessment of an impending relapse. Therefore MRD has gained a prominent position in many ALL treatment studies as tool for tailoring therapy with growing evidence that MRD supersedes most conventional stratification criteria at least for Ph-negative ALL. Most study protocols on adult ALL follow a two step approach with a first classical pretherapeutic and a second MRD-based risk stratification. Here we discuss whether and how MRD is ready to be used as main decisive marker and whether pretherapeutic factors and MRD are really competing or complementary tools to individualize treatment.
Blood , résumé, 2012