CC BY-NC-ND 4.0 · Indian J Med Paediatr Oncol 2021; 42(01): 071-076
DOI: 10.1055/s-0041-1729730
Trainees’ Corner

Minimal Residual Disease in Acute Lymphoblastic Leukemia

Pratik P. Patil
1   Department of Medical Oncology, Max Super Speciality Hospital, New Delhi, India
Esha Jafa
2   Department of Medical Oncology, Super Speciality Cancer Institute, Lucknow, Uttar Pradesh, India
Mayank Aggarwal
1   Department of Medical Oncology, Max Super Speciality Hospital, New Delhi, India
› Author Affiliations

Acute lymphoblastic leukemia (ALL) is the most common malignancy in children accounting for 25 and 75% of childhood cancers and leukemia, respectively, citied as the major success stories in the world of oncology where the cure rates have gone up to 80% (event-free survival [EFS]) from literally zero in the 1950s.[1] [2] [3] Prognostic factors play an important role in the strategic standard management of ALL wherein minimal residual disease (MRD) is now widely regarded as a clinically significant tool. A meta-analysis has proven that MRD negativity is directly proportional to the powerful predictors of disease-free survival (DFS) (hazard ratio [HR]: 0.23, [95% Bayesian credible interval [BCI]: 0.18–0.28] for pediatric patients and 0.28 [95% BCI: 0.24–0.33] for adults) and overall survival (OS) (HR: 0.28, [95% BCI: 0.19–0.41] and 0.28 [95% BCI: 0.20–0.39] for children and adults with ALL, respectively).[4]

It now provides information depending on when the MRD assessment was performed: after induction therapy, after consolidation therapy (CT), or before and after stem cell transplant (SCT) and genomic information for targetable therapies available today, as shown in [Table 1]. As of today, for the management of ALL, induction therapy to aim complete hematological recovery and complete remission (CR), followed by CT after attainment of CR, with standard central nervous system (CNS) prophylaxis, is imperative. It is followed by SCT in few subsets. Mostly all pediatric and adult ALL guidelines have introduced informative checkpoints during the management of ALL. For pediatric subgroup, MRD negativity on day 15 of induction chemotherapy defines excellent outcomes, wherein in adults, MRD is taken later in the course at 4 weeks of starting induction chemotherapy and defines better survival rates.[5] [6]

Table 1

Genetic classification by prognosis of B-cell acute lymphoblastic leukemia

Good prognosis

Intermediate prognosis

Poor prognosis

Undetermined prognosis

Abbreviations: ALL, acute lymphoblastic leukemia; MLL, mixed-lineage leukemia.

at(5; 14); IL3-IGH is a World Health Organization-classified acute leukemia and prognosis data has not been determined.

Hyperdiploid karyotypes

t(1; 19); TCF3-PBX1

Hypodiploid karyotypes

t(5; 14); IL3-IGHa

t(12; 21); ETV6-RUNX1 (TEL-AML1)

t(9; 22); BCR-ABL

Philadelphia-like ALL

11q23 MLL arrangements

Publication History

Article published online:
28 May 2021

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