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Immunologic monitoring in adults with acute lymphoblastic leukemia
María-Belén Vidriales1, Alberto Orfao, Jesús F San-Miguel
1Hematology Department, University Hospital of Salamanca, Paseo de San Vicente 58-182, 37007 Salamanca, Spain. mbvidri@usal.es
Insights
Immunophenotypic minimal residual disease (MRD) detection using flow cytometry is crucial for monitoring adult acute lymphoblastic leukemia (ALL). This method helps predict relapse risk and guide treatment decisions in ALL patients.
Area of Science:
- Hematology
- Immunology
- Oncology
Background:
- Minimal residual disease (MRD) monitoring is vital for acute leukemia management.
- Multiparameter flow cytometry (MFC) identifies unique phenotypes in over 90% of adult acute lymphoblastic leukemia (ALL) cases at diagnosis.
- Previous MRD studies in ALL predominantly focused on pediatric populations, leaving adult data limited.
Purpose of the Study:
- To review the technical aspects of MRD detection by flow cytometry in adult ALL.
- To evaluate the clinical utility of immunophenotypic MRD studies for relapse prediction in adult ALL.
- To advocate for the integration of MRD assessment into routine adult ALL patient care.
Main Methods:
- Utilizing multiparameter flow cytometry with triple or quadruple marker combinations.
- Identifying aberrant or uncommon phenotypic profiles in leukemic cells.
- Analyzing bone marrow and peripheral blood samples for residual leukemic cells post-remission.
Main Results:
- Immunophenotypic profiles effectively identify residual leukemic cells in adult ALL patients.
- Flow cytometry offers a reliable method for MRD detection in ALL.
- Existing data, though limited, suggests the clinical value of MRD assessment in adults.
Conclusions:
- Immunophenotypic MRD studies are clinically valuable for adult ALL management.
- Routine MRD assessment can identify high-risk patients who may benefit from novel therapies.
- Distinguishing patient risk groups aids in tailoring conventional treatment approaches for better outcomes.
Abstract:
Investigation of minimal residual disease (MRD) by immunophenotyping and molecular techniques has proven to be a powerful approach for disease monitoring in patients with acute leukemia. Multiparameter flow cytometry, through the use of triple or quadruple marker combinations, identifies aberrant or uncommon phenotypic profiles in more than 90% of adult patients with acute lymphoblastic leukemia (ALL) at diagnosis. These profiles allow identification of residual leukemic cells in bone marrow or peripheral blood once morphologic complete remission is achieved. Until now, most immunophenotypic MRD studies in ALL have focused on children. In contrast, information on the value of MRD in adults with ALL is scanty and usually restricted to polymerase chain reaction studies. In this review, we focus on technical aspects of MRD detection by flow cytometry and on the clinical data concerning the value of immunologic MRD studies as a tool for relapse prediction in adult ALL. Although prospective studies are needed, we assert that immunophenotypic MRD studies are clinically useful. Such studies should be incorporated into the routine management of adult ALL patients for identification of those at high risk of relapse, who could benefit from new alternative therapeutic approaches, and to distinguish these patients from others who could be cured with more conventional approaches.
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