Disease detection methodologies in relapsed B‐cell acute lymphoblastic leukemia: Opportunities for improvement

• Published in: Pediatric blood & cancer Vol. 67; no. 4; pp. e28149 - n/a
• Main Authors: Shalabi, Haneen, Yuan, Constance M., Kulshreshtha, Amita, Dulau‐Florea, Alina, Salem, Dalia, Gupta, Gaurav K., Roth, Mark, Filie, Armando C., Yates, Bonnie, Delbrook, Cindy, Derdak, Joanne, Mackall, Crystal L., Lee, Daniel W., Fry, Terry J., Wayne, Alan S., Stetler‐Stevenson, Maryalice, Shah, Nirali N.
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.04.2020
• Subjects: Acute lymphoblastic leukemia; Adolescent; Adult; Biopsy; Bone marrow; Bone Marrow - pathology; Central nervous system; Cerebrospinal fluid; Child; Child, Preschool; CSF; Cytopathology; Female; Flow cytometry; Flow Cytometry - methods; Follow-Up Studies; Hematology; Hematopoietic Stem Cell Transplantation - methods; Humans; Immunophenotyping; Leukemia; Lymphatic leukemia; Male; Minimal residual disease; Neoplasm Recurrence, Local - pathology; Neoplasm Recurrence, Local - therapy; Neoplasm, Residual - pathology; Neoplasm, Residual - therapy; Oncology; Pediatrics; Precursor B-Cell Lymphoblastic Leukemia-Lymphoma - pathology; Precursor B-Cell Lymphoblastic Leukemia-Lymphoma - therapy; Prognosis; Retrospective Studies; Sampling error; Young Adult; Young adults; acute lymphoblastic leukemia; minimal residual disease; CSF
• ISSN: 1545-5009; 1545-5017; 1545-5017
• DOI: 10.1002/pbc.28149

Background Accurate disease detection is integral to risk stratification in B‐cell acute lymphoblastic leukemia (ALL). The gold standard used to evaluate response in the United States includes morphologic evaluation and minimal residual disease (MRD) testing of aspirated bone marrow (BM) by flow cytometry (FC). This MRD assessment is usually made on a single aspirate sample that is subject to variability in collection techniques and sampling error. Additionally, central nervous system (CNS) assessments for ALL include evaluations of cytopathology and cell counts, which can miss subclinical involvement. Procedure We retrospectively compared BM biopsy, aspirate, and FC samples obtained from children and young adults with relapsed/refractory ALL to identify the frequency and degree of disease discrepancies in this population. We also compared CNS FC and cytopathology techniques. Results Sixty of 410 (14.6%) BM samples had discrepant results, 41 (10%) of which were clinically relevant as they resulted in a change in the assignment of marrow status. Discrepant BM results were found in 28 of 89 (31.5%) patients evaluated. Additionally, cerebrospinal fluid (CSF) FC identified disease in 9.7% of cases where cytopathology was negative. Conclusions These results support further investigation of the role of concurrent BM biopsy, with aspirate and FC evaluations, and the addition of FC to CSF evaluations, to fully assess disease status and response, particularly in patients with relapsed/refractory ALL. Prospective studies incorporating more comprehensive analysis to evaluate the impact on clinical outcomes are warranted.