Posters
Presenting Author Academic/Professional Position
Medical Student
Academic Level (Author 1)
Faculty
Discipline/Specialty (Author 1)
Pediatrics
Academic Level (Author 2)
Medical Student
Presentation Type
Poster
Discipline Track
Clinical Science
Abstract Type
Research/Clinical
Abstract
Background: Despite significant advancements in the treatment of pediatric B-cell acute lymphoblastic leukemia (B-ALL), chemotherapy has reached its end of “intensification” stage despite improvements in supportive care. Moreover, relapse remains a major challenge, particularly in high-risk populations such as adolescents and young adults (AYAs). The definition of threshold for clinical relapse as 25% presence of marrow lymphoblasts was established decades ago, which may be incoherent with current therapeutic strategies and delay the window for timely treatment for relapsed patients. Emerging data suggest that early detection of minimal residual disease (MRD) may offer an opportunity to intervene before clinical relapse, improving patient outcomes. This commentary evaluates the role of MRD surveillance and intervention strategies in addressing treatment failure and relapse in pediatric B-ALL.
Methods: This commentary synthesizes data from cohort studies, clinical trials, and guideline recommendations published between 2018 and 2024. Key studies include reports on the efficacy of MRD-guided therapy (Wang et al., 2020; Cheng et al., 2018), the predictive value of MRDreappearance (Rau et al., 2022; Muffly et al., 2023), and the impact of novel therapies such as blinatumomab and CAR-T cells (Queudeville et al., 2023). Additionally, we review the feasibility of next-generation sequencing (NGS) as a tool for peripheral blood monitoring and discuss clinical guidelines advocating MRD surveillance in pediatric patients, especially AYAs.
Results: Emerging evidence demonstrates that MRD reappearance reliably predicts relapse in pediatric B-ALL, and MRD surveillance has already been incorporated to adult ALL treatment guidelines (Shah et al. 2024; Gökbuget et al. 2024). A study by Wang et al. (2020) revealed that patients with MRD reappearance had significantly worse event-free survival (38.4%) compared to those with continuously negative MRD (88.5%), and an MRD cutoff at 0.15% gives the best discrimination. Additionally, early intervention after MRD reemergence with HSCT has shown significantly higher survival rates and lower rates of relapse (p
Conclusions: Implementing MRD surveillance in pediatric B-ALL may allow for earlier detection of treatment failure, enabling timely interventions with targeted therapies that facilitate a higher likelihood of remission. This strategy holds promise for reducing relapse rates and improving long-term outcomes, particularly in high-risk groups including AYAs. Further prospective studies are needed to establish standardized protocols and refine the use of peripheral blood NGS in routine clinical practice.
Recommended Citation
Gaynon, Paul S. and Li, Linwei, "Clinical Relapse Versus Treatment Failure: The Case for Surveillance for Re-Appearance of Minimal Measurable Disease in Pediatric Patients with Higher Risk B-ALL" (2025). Research Symposium. 93.
https://scholarworks.utrgv.edu/somrs/2025/posters/93
Included in
Clinical Relapse Versus Treatment Failure: The Case for Surveillance for Re-Appearance of Minimal Measurable Disease in Pediatric Patients with Higher Risk B-ALL
Background: Despite significant advancements in the treatment of pediatric B-cell acute lymphoblastic leukemia (B-ALL), chemotherapy has reached its end of “intensification” stage despite improvements in supportive care. Moreover, relapse remains a major challenge, particularly in high-risk populations such as adolescents and young adults (AYAs). The definition of threshold for clinical relapse as 25% presence of marrow lymphoblasts was established decades ago, which may be incoherent with current therapeutic strategies and delay the window for timely treatment for relapsed patients. Emerging data suggest that early detection of minimal residual disease (MRD) may offer an opportunity to intervene before clinical relapse, improving patient outcomes. This commentary evaluates the role of MRD surveillance and intervention strategies in addressing treatment failure and relapse in pediatric B-ALL.
Methods: This commentary synthesizes data from cohort studies, clinical trials, and guideline recommendations published between 2018 and 2024. Key studies include reports on the efficacy of MRD-guided therapy (Wang et al., 2020; Cheng et al., 2018), the predictive value of MRDreappearance (Rau et al., 2022; Muffly et al., 2023), and the impact of novel therapies such as blinatumomab and CAR-T cells (Queudeville et al., 2023). Additionally, we review the feasibility of next-generation sequencing (NGS) as a tool for peripheral blood monitoring and discuss clinical guidelines advocating MRD surveillance in pediatric patients, especially AYAs.
Results: Emerging evidence demonstrates that MRD reappearance reliably predicts relapse in pediatric B-ALL, and MRD surveillance has already been incorporated to adult ALL treatment guidelines (Shah et al. 2024; Gökbuget et al. 2024). A study by Wang et al. (2020) revealed that patients with MRD reappearance had significantly worse event-free survival (38.4%) compared to those with continuously negative MRD (88.5%), and an MRD cutoff at 0.15% gives the best discrimination. Additionally, early intervention after MRD reemergence with HSCT has shown significantly higher survival rates and lower rates of relapse (p
Conclusions: Implementing MRD surveillance in pediatric B-ALL may allow for earlier detection of treatment failure, enabling timely interventions with targeted therapies that facilitate a higher likelihood of remission. This strategy holds promise for reducing relapse rates and improving long-term outcomes, particularly in high-risk groups including AYAs. Further prospective studies are needed to establish standardized protocols and refine the use of peripheral blood NGS in routine clinical practice.
