Early diagnosis and targeted treatment of very high-risk childhood acute lymphoblastic leukaemia

Within therapy optimization trial ALL-BFM 2000, extended minimal residual disease (MRD) analysis is able to identify a group of patients displaying molecular persistance of leukemia cells on a high level throughout conventional treatment (VHRL, very high-risk leukemia). A persisting MRD load of 10-3 or more after four intensive high-risk therapy blocks seems to indicate a critical prognostic threshold. Although MRD is a strong prognostic tool, it can provide this information only weeks after diagnosis and, in addition, does not yield any insights into the mechanism of treatment response or resistance. Therefore,…