Cross-sectional physician survey on the use of minimal residual disease testing in the management of pediatric and adult patients with acute lymphoblastic leukemia

Objectives: Minimal residual disease (MRD) is a strong prognostic factor in acute lymphoblastic leukemia (ALL), which progresses quickly and is fatal within months if untreated. This study explored use of MRD testing in adult and pediatric B-cell ALL patients, and academic versus community settings.

Methods: A survey was administered to US-based hematologists/oncologists currently managing ≥5 B-cell ALL patients and using MRD tests. Descriptive analyses (frequencies and percentages) and Pearson’s chi square testing assessed any differences in various characteristics.

Results: 150 adult treaters (treating physicians: 100 community, 50 academic) and 30 pediatric treaters participated. Use of MRD testing was higher among pediatric treaters (93% of patients) than adult treaters (73% of patients) (p < 0.05), and higher among adult treaters at academic centers than in community settings (84% and 67% of patients, respectively; p < 0.01). MRD testing is part of a standard protocol for 93% of pediatric treaters versus 53% of adult treaters. Pediatric treaters most commonly administer an MRD test during/after induction or upon relapse. No consensus on timing among adult treaters was noted.

Discussion: MRD testing is an important tool in the prediction of relapse in ALL. Resolving barriers could improve detection of molecular relapse in patients with ALL, particularly among adults and in community settings.

Conclusion: MRD testing is fairly common in treatment of ALL, but some barriers still exist in access.