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Open AccessArticle

Consensus Recommendations for MRD Testing in Adult B-Cell Acute Lymphoblastic Leukemia in Ontario

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Laboratory Medicine Program, Hematopathology, University Health Network, Toronto, ON M5G 2C4, Canada
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Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A8, Canada
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Laboratory Medicine Program, Division of Clinical Laboratory Genetics, University Health Network, Toronto, ON M5G 2C4, Canada
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Department of Pathology and Molecular Medicine, Hamilton Health Sciences, McMaster University, Hamilton, ON L8S 4L8, Canada
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Department of Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada
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The Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, Canada
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Department of Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada
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Hamilton Regional Laboratory Medicine Programme, Hamilton Health Sciences, Hamilton, ON L8N 4A6, Canada
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London Health Sciences Centre, Molecular Genetics Laboratory, Molecular Diagnostics Division, London, ON N6A 5W9, Canada
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Department of Pathology and Laboratory Medicine, Western University, London, ON N6A 5C1, Canada
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Princess Margaret Cancer Centre, Division of Medical Oncology and Hematology, Toronto, ON M5G 2M9, Canada
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Department of Medicine, University of Toronto, Toronto, ON M5S 3H2, Canada
*
Author to whom correspondence should be addressed.
Curr. Oncol. 2021, 28(2), 1376-1387; https://doi.org/10.3390/curroncol28020131
Received: 9 February 2021 / Revised: 18 March 2021 / Accepted: 29 March 2021 / Published: 30 March 2021
(This article belongs to the Section Hematology)
Measurable (minimal) residual disease (MRD) is an established, key prognostic factor in adult B-cell acute lymphoblastic leukemia (B-ALL), and testing for MRD is known to be an important tool to help guide treatment decisions. The clinical value of MRD testing depends on the accuracy and reliability of results. Currently, there are no Canadian provincial or national guidelines for MRD testing in adult B-ALL, and consistent with the absence of such guidelines, there is no uniform Ontario MRD testing consensus. Moreover, there is great variability in Ontario in MRD testing with respect to where, when, and by which technique, MRD testing is performed, as well as in how the results are interpreted. To address these deficiencies, an expert multidisciplinary working group was convened to define consensus recommendations for improving the provision of such testing. The expert panel recommends that MRD testing should be implemented in a centralized manner to ensure expertise and accuracy in testing for this low volume indication, thereby to provide accurate, reliable results to clinicians and patients. All adult patients with B-ALL should receive MRD testing after induction chemotherapy. Philadelphia chromosome (Ph)-positive patients should have ongoing monitoring of MRD during treatment and thereafter, while samples from Ph-negative B-ALL patients should be tested at least once later during treatment, ideally at 12 to 16 weeks after treatment initiation. In Ph-negative adult B-ALL patients, standardized, ideally centralized, protocols must be used for MRD testing, including both flow cytometry and immunoglobulin (Ig) heavy chain and T-cell receptor (TCR) gene rearrangement analysis. For Ph-positive B-ALL patients, MRD testing using a standardized protocol for reverse transcription real-time quantitative PCR (RT-qPCR) for the BCR-ABL1 gene fusion transcript is recommended, with Ig/TCR gene rearrangement analysis done in parallel likely providing additional clinical information. View Full-Text
Keywords: adult B-cell acute lymphoblastic leukemia; adult acute lymphoblastic leukemia; flow cytometry; minimal residual disease; measurable residual disease; next-generation sequencing; polymerase chain reaction adult B-cell acute lymphoblastic leukemia; adult acute lymphoblastic leukemia; flow cytometry; minimal residual disease; measurable residual disease; next-generation sequencing; polymerase chain reaction
MDPI and ACS Style

Tierens, A.; Stockley, T.L.; Campbell, C.; Fulcher, J.; Leber, B.; McCready, E.; Sabatini, P.J.B.; Sadikovic, B.; Schuh, A.C. Consensus Recommendations for MRD Testing in Adult B-Cell Acute Lymphoblastic Leukemia in Ontario. Curr. Oncol. 2021, 28, 1376-1387. https://doi.org/10.3390/curroncol28020131

AMA Style

Tierens A, Stockley TL, Campbell C, Fulcher J, Leber B, McCready E, Sabatini PJB, Sadikovic B, Schuh AC. Consensus Recommendations for MRD Testing in Adult B-Cell Acute Lymphoblastic Leukemia in Ontario. Current Oncology. 2021; 28(2):1376-1387. https://doi.org/10.3390/curroncol28020131

Chicago/Turabian Style

Tierens, Anne; Stockley, Tracy L.; Campbell, Clinton; Fulcher, Jill; Leber, Brian; McCready, Elizabeth; Sabatini, Peter J.B.; Sadikovic, Bekim; Schuh, Andre C. 2021. "Consensus Recommendations for MRD Testing in Adult B-Cell Acute Lymphoblastic Leukemia in Ontario" Curr. Oncol. 28, no. 2: 1376-1387. https://doi.org/10.3390/curroncol28020131

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