A 35-year-old man with Philadelphia chromosome-positive ALL is in complete haematological remission after induction with ponatinib plus mini-hyper-CVD. Measurable residual disease (MRD) by flow cytometry remains detectable at 10^−3. Which statement regarding subsequent management is MOST accurate?
- A MRD negativity after consolidation is associated with improved overall survival and a key endpoint in Ph+ ALL trials ✓
- B MRD positivity at this level after induction does not alter prognosis or treatment strategy
- C Allogeneic SCT should be deferred until MRD is eradicated by continued ponatinib
- D Blinatumomab is not active in Ph+ ALL
Explanation
In Ph+ ALL, MRD status assessed by flow cytometry or PCR for BCR-ABL transcript is a critical prognostic and treatment-guiding factor. MRD negativity after consolidation correlates strongly with improved event-free and overall survival across multiple contemporary trials (including MDACC ponatinib trials). Achieving MRD negativity before allogeneic SCT improves outcomes. Blinatumomab, a CD3/CD19 BiTE antibody construct, is active in Ph+ ALL and is incorporated into protocols to deepen MRD responses. Persistent MRD at 10^−3 warrants escalation of therapy to achieve MRD negativity before transplant.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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