A look into the future: can minimal residual disease guide therapy and predict prognosis in chronic lymphocytic leukemia?

Abstract

Over the past 2 decades, dramatic improvements in the efficacy of treatments for chronic lymphocytic leukemia have led to progressively higher percentages of clinical complete remissions. A molecular eradication of the leukemia has become not only a desirable, but also an achievable, end point that needs to be evaluated within clinical trials. The assessment of complete remission only at the clinical and morphological level is insufficient, at least for physically fit patients. The detection of minimal residual disease (MRD) in chronic lymphocytic leukemia has become feasible using PCR-based or flow cytometric techniques that reproducibly allow reaching the detection level of less than 1 leukemic cell per 10 000 leukocytes (10(-4)), the level currently defined as MRD(-) status. Emerging data indicate that the MRD status during and at the end of treatment is one of the most powerful predictors of progression-free and overall survival. This predictor appears to be independent of clinical response, type or line of therapy, and known biological markers. For these reasons, the time is ripe to test the use of MRD as a surrogate marker of clinical end points and as a real-time marker of efficacy and/or resistance to the administered therapies. In the near future, clinical trials will determine whether MRD assessment can be used for guiding therapy, either to improve quality of responses through consolidation or to prevent relapses through preemptive therapies based on the reappearance of MRD.

• Authors: Paolo Ghia
• Journal: Hematology. American Society of Hematology. Education Program (Hematology Am Soc Hematol Educ Program) Vol. 2012 Pg. 97-104 ( 2012) ISSN: 1520-4383 [Electronic] United States
• PMID: 23233566 (Publication Type: Journal Article, Review)

Chemical References

• Antineoplastic Agents
• Biomarkers
• Biomarkers, Tumor

Topics

• Antineoplastic Agents (pharmacology)
• Biomarkers
• Biomarkers, Tumor
• Clinical Trials as Topic
• Disease-Free Survival
• Flow Cytometry (methods)
• Humans
• Immunotherapy (methods)
• Leukemia, Lymphocytic, Chronic, B-Cell (diagnosis, drug therapy, immunology)
• Neoplasm, Residual (diagnosis)
• Phenotype
• Polymerase Chain Reaction (methods)
• Prognosis
• Recurrence
• Remission Induction
• Treatment Outcome