OBJECTIVES

The presence of MRD in patients with Philadelphia chromosome-negative (Ph–) B-cell precursor (BCP) ALL in first complete remission (CR1) is an important negative prognostic factor. Evidence suggests that long-term survival can be achieved among patients with MRD+ by eradicating MRD. This study examined the concept of cure, the role of hematopoietic stem cell transplant (HSCT) in treatment, and long-term mortality risk in Ph– BCP ALL patients in CR1 in relation to MRD.

METHODS

A two-phase Delphi panel was conducted with four hematologists / hemato-oncologists from Germany with expertise in treating adults with ALL. Participants completed a questionnaire which gathered information about experience in treating ALL including treatments and outcomes using semi-structured and open-ended questions. Responses were discussed by all participants in a web-based meeting. Participant “poll” questions were used to establish if consensus (defined here as 75% agreement) was achieved on specific statements.

RESULTS

Participants had a median of 20 years of experience treating adults with BCP-ALL and had treated a median of 10 Ph– BCP-ALL patients in the previous year (Range:8-20). Participants agreed that: cure is highly probable at 5 years of relapse-free survival (RFS) for patients who are MRD+ at CR1, and cure rates would be lower among patients’ ineligible for HSCT for patients in CR1 with MRD+ (participants provided their response within the current standard of care chemotherapy). Participants estimated that 50-60% of patients in CR1 with MRD+ who subsequently became MRD- after additional treatment can achieve cure.

CONCLUSIONS

This study provides evidence via clinical consensus on the concept of cure in patients with BCP-ALL with MRD at CR1 in Germany, and that cure can be achieved in these patients by eradicating MRD. Implications of this research are that therapies that eradicate MRD and induce long-term RFS may increase the chance of cure.