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Detection of minimal residual disease in ALL

  • Chapter
Leukemia: Advances in Research and Treatment

Part of the book series: Cancer Treatment and Research ((CTAR,volume 64))

Abstract

Complete remission (CR) of acute leukemia is defined in clinical practice as the presence in the bone marrow of less than 5% blast cells, a level determined by the limits of reliable detection by morphology. Mathematical models predict that the level of residual disease during clinical remission could vary from 1010 leukemic cells following early remission induction to perhaps none in some patients at later stages of treatment [1]. The practical relevance of minimal residual disease (MRD) is in the relationship between the level of the residual tumor burden and the risk of relapse. The ability to detect and quantitate MRD in hematological malignancies and to relate this to relapse risk could potentially provide a means of monitoring the effectiveness of treatment and the basis for design of more stratified treatment protocols. It is, however, worth emphasizing that the detection of residual disease by sensitive techniques does not necessarily predict relapse. There are instances in the literature both of ‘clonal’ remissions [2] and stable persistence of residual disease during remission [3]. The large body of work on the influence of immune effector mechanisms in the control or elimination of residual disease provides a potential basis for some of these observations (see [4]). Clearly, prediction of relapse cannot be determined solely by the presence of a given burden of residual disease; assessment of a variety of additional parameters, including the viability and clonal nature of residual cells, is also necessary.

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  1. Miriam Deane
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  2. A. Victor Hoffbrand
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  1. M.D. Anderson Cancer Center, The University of Texas, USA

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Deane, M., Hoffbrand, A.V. (1993). Detection of minimal residual disease in ALL. In: Freireich, E.J., Kantarjian, H. (eds) Leukemia: Advances in Research and Treatment. Cancer Treatment and Research, vol 64. Springer, Boston, MA. https://doi.org/10.1007/978-1-4615-3086-2_8

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