VIDEO: Evaluating treatment response and relapse likelihood in ALL

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So, in addition to improvements in our understanding of the molecular and genetic basis of ALL, we're also learning more about prognosis and determining who is likely to respond to various treatments. I would say that in terms of predicting a response and likelihood of relapse, there are sort of two major categories. One is the molecular and genetic profile at diagnosis.

We know that certain subgroups of ALL are more likely to respond to chemotherapy, be cured without transplant, and other subtypes are more likely to be chemotherapy resistant and really benefit from escalated therapy with allogeneic stem cell transplant or other escalated treatment protocols. The other factor that's really important is to monitor how patients are responding to treatment. You maybe start off with a particular expectation but you monitor how you do, see if patients respond as anticipated. And that is generally based on both standard measures of response based on morphology, bone marrow biopsies, but also increasingly sophisticated tests looking at so-called measurable residual disease, or MRD. That can be based on either flow cytometry or very sensitive flow cytometry.

And increasingly we're also using molecular next-generation sequencing assays to look for levels of MRD that can be more sensitive and specific for those patients who have a trackable flow. For patients with ALL, it's really important to think of the diagnosis. How are you going to track response, what's the MRD assay that you're going to use, and really make sure that the right framework is set up from the beginning to then follow over time.