Nicholas Short, MD, on the Surprising Significance of CR Outcomes for Patients With ALL After Frontline Therapy

In an interview with CancerNetwork®, Nicholas J. Short, MD, of the University of Texas MD Anderson Cancer Center, described the importance of the time point of complete remission (CR) for patients with acute lymphoblastic leukemia (ALL) after frontline therapy in the findings from next-generation sequencing-based minimal residual disease study presented at the 2020 American Society of Hematology (ASH) Annual Meeting & Exposition.

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We didn’t know how deep of a level of achievement of MRD you could get after just 1 cycle of therapy. And then we found that we [could] specifically use the CR time points—in other words, essentially after 1 cycle of therapy, that’s really what stratified patients according to outcomes best. When we looked at post CR outcomes—or post CR time points [of] 2, 3, 4 months into therapy—achievement of MRD negativity was still important, but it wasn’t as prognostic as it was at the time of CR. In particular, one thing that was a bit surprising was just how prognostic it was. For example, we only had 1 patient relapse who was MRD negative by the NGS [nest-generation sequencing] assay at the time of CR, and this patient was later able to be salvaged. The long-term survival for these patients was actually 100% [in those] who were MRD negative at the time of remission. I think the significance of it in the sense of how much we can identify these patients with very low risk of relapse was a bit surprising.