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2015 ; 125
(26
): 3996-4009
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English Wikipedia
Minimal residual disease diagnostics in acute lymphoblastic leukemia: need for
sensitive, fast, and standardized technologies
#MMPMID25999452
van Dongen JJ
; van der Velden VH
; Brüggemann M
; Orfao A
Blood
2015[Jun]; 125
(26
): 3996-4009
PMID25999452
show ga
Monitoring of minimal residual disease (MRD) has become routine clinical practice
in frontline treatment of virtually all childhood acute lymphoblastic leukemia
(ALL) and in many adult ALL patients. MRD diagnostics has proven to be the
strongest prognostic factor, allowing for risk group assignment into different
treatment arms, ranging from significant treatment reduction to mild or strong
intensification. Also in relapsed ALL patients and patients undergoing stem cell
transplantation, MRD diagnostics is guiding treatment decisions. This is also why
the efficacy of innovative drugs, such as antibodies and small molecules, are
currently being evaluated with MRD diagnostics within clinical trials. In fact,
MRD measurements might well be used as a surrogate end point, thereby
significantly shortening the follow-up. The MRD techniques need to be sensitive
(?10(-4)), broadly applicable, accurate, reliable, fast, and affordable. Thus
far, flow cytometry and polymerase chain reaction (PCR) analysis of rearranged
immunoglobulin and T-cell receptor genes (allele-specific oligonucleotide
[ASO]-PCR) are claimed to meet these criteria, but classical flow cytometry does
not reach a solid 10(-4), whereas classical ASO-PCR is time-consuming and labor
intensive. Therefore, 2 high-throughput technologies are being explored, ie,
high-throughput sequencing and next-generation (multidimensional) flow cytometry,
both evaluating millions of sequences or cells, respectively. Each of them has
specific advantages and disadvantages.