what is the expected value in mrd results for leukemia treatment in children

Leukemia is the most common form of childhood cancer. 1, 2 The combination of empiric optimization of treatment protocols, better supportive care, therapeutic targeting of specific disease mechanisms, and risk‐adapted treatment intensity has resulted in long‐term survival of 80–90% for acute lymphoblastic leukemia

(ALL) 3 - 6 and 60–70% for acute myeloid leukemia (AML). 7 - 9 The success of this approach depends on accurate prediction of relapse risk allowing aggressive front‐line therapy for poor risk groups to avert leukemic relapse, for which survival is poor, and reduction in treatment intensity for favorable risk groups to avoid long‐term toxicities. 10 Risk stratification based on patient‐related (e.g., age) and leukemia‐related (e.g., immunophenotype and genetic abnormalities) prognostic factors and morphological assessment of individual treatment response is unable to accurately identify the majority of children at increased risk of treatment failure.

Full Answer

What is the optimal target for MRD assessment in leukocytoclastic leukemia?

Overall, more than 40% of ALL patients carry chromosomal translocations that generate chimeric transcripts: these are potentially ideal targets for MRD assessment (46, 47), since they are main driver events, are expressed in all leukemic cells and are extremely stable during the course of the disease.

Does MRD increase the risk of relapse in leukemia?

In general, children with MRD during or after induction chemotherapy are more likely to have the leukemia relapse (come back) and therefore may need more intense treatment. Children with more MRD have a greater risk of relapse than those with less MRD.

How should MRD markers be evaluated for AML cells?

For new MRD markers, the expression level in AML cells should be evaluated. Detailed recommendations for MRD assays detecting RUNX1-RUNX1T1, CBFB-MYH11, and PML-RARAhave been published by the Europe Against Cancer initiative, including appropriate housekeeping genes.50,51 Each MRD analysis by PCR should be run in triplicate.

What is the prognosis of pediatric acute myeloid leukemia (AML)?

Although children with DS and AML have an overall favorable prognosis, determining the appropriate curative chemotherapy dose intensity while minimizing treatment-related toxicity remains a clinical challenge.

How do you read MRD results?

An MRD positive test result means that residual (remaining) disease was detected. A negative result means that residual disease was not detected. After treating cancer, any remaining cancer cells in the body can become active and start to multiply, causing a relapse of the disease.

What is considered MRD positive?

A positive MRD test means that cancer cells were found. This does not necessarily mean you're no longer in remission, but it does mean there is a risk of the cancer returning. This result also might indicate that you and the doctor may need to discuss new treatment options.

What is considered MRD negative?

MRD negativity was defined as the absence of tumor plasma cell within 1 000 000 bone marrow cells (<10−6). Data were analyzed from a recent clinical trial that evaluated the role of transplantation in newly diagnosed myeloma patients treated with lenalidomide, bortezomib, and dexamethasone (RVD).

What is MDR in leukemia?

Resistance of tumors to chemotherapeutic agents is an important factor that limits the successful treatment of a wide range of malignancies. The multidrug resistant (MDR) phenotype is well recognized in clinical samples, and it has been extensively studied, particularly in acute myeloid leukemia.

Does MRD mean remission?

What is minimal residual disease (MRD)? BY Clayton Boldt, Ph. D. After completing a course of treatment, there are few words that sound better to a patient than “complete remission.” It's an indication that the treatment has worked, and there is no evidence of cancer based on scans or lab tests.

What is minimal residual?

(MIH-nih-mul ree-ZID-yoo-ul dih-ZEEZ) A term used to describe a very small number of cancer cells that remain in the body during or after treatment. Minimal residual disease can be found only by highly sensitive laboratory methods that are able to find one cancer cell among one million normal cells.

What is MRD in CLL?

Minimal residual disease (MRD) in CLL is defined as the number of leukemic cells that can be detected in peripheral blood (PB) or bone marrow (BM) following treatment. Undetectable MRD (uMRD) is currently defined as the presence of less than 1 CLL cell in 10,000 leukocytes (<10 −4).

What is bone marrow MRD?

Minimal residual disease (MRD) is the name given to small numbers of leukaemic cells (cancer cells from the bone marrow) that remain in the person during treatment, or after treatment when the patient is in remission (no symptoms or signs of disease). It is the major cause of relapse in cancer and leukemia.

What is minimal residual disease in AML?

Measurable residual disease (MRD; previously termed minimal residual disease) is an independent, postdiagnosis, prognostic indicator in acute myeloid leukemia (AML) that is important for risk stratification and treatment planning, in conjunction with other well-established clinical, cytogenetic, and molecular data ...

What does residual lesion mean?

Based on our previous report,7 residual lesions are defined as those that appeared on the first postoperative study performed within 12 months of endarterectomy. Recurrent stenoses are defined as those that appeared subsequent to a normal duplex examination or more than 12 months after the initial examination.

What is MRD transplant?

MRD is used for stem cell transplantation (SCT) selection in the large subgroup of patients with an intermediate risk profile. Patients who are MRD positive will benefit from allo-SCT. However, MRD-negative patients have a better chance of survival after SCT.

What is residual malignancy?

Cancer cells that remain after attempts to remove the cancer have been made.