International Cross-Age Consensus Guideline on Measurable Residual Disease Assessment in Acute Lymphoblastic Leukemia
Year: 2026
Type: article
Abstract: Measurable residual disease (MRD) assessment is central to risk stratification, response evaluation, and relapse detection in acute lymphoblastic leukemia (ALL). However, substantial global variability in its methodology and implementation persists. Differences in sampling strategies, detection methods, reporting thresholds, and interpretation criteria hinder cross-trial comparability and clinical standardization. To address this, an international expert panel representing major pediatric and adult study groups and reference laboratories developed consensus recommendations, using a structured current-practices survey followed by a multi-round Delphi process. Consensus was achieved on 38 of 41 statements. Recommendations span three domains: pre-analytical requirements, technical and nomenclature standards, and MRD-based remission and relapse definitions. Bone marrow was endorsed as the reference specimen for MRD assessment, and MRD was prioritized over cytomorphology in cases of discordance. Principles for risk- and actionability-guided late MRD monitoring, confirmation of MRD reappearance, and MRD-informed relapse assessment were also defined. Among the key technical consensus statements, a standardized MRD assay nomenclature was adopted. Areas without consensus-namely, anticoagulant choice for PCR-based MRD, interpretation of isolated BCR::ABL1 reconversion, and the exclusive use of MRD to define remission-highlight ongoing biological and clinical complexity. This guideline, applicable across all ages, provides a practical framework to standardize MRD assessment in ALL and support MRD-guided clinical decision-making.
Source: Blood
Authors: Michaela Kotrova, Julia Alten, Andrea Biondi, Barbara Buldini, Mireia Camos, Gunnar Cario, Giovanni Cazzaniga, Sabina Chiaretti, Emmanuelle Clappier, Pritha Dasgupta, Daniela Drandi, Cornelia Eckert, Sarah Elitzur, Adele K Fielding, Eva Fronkova, Nicola Gökbuget, Michelle J Henderson, Abhirupa Kar, Seth E. Karol, Irene Della Starza, Britta Kehden, Csongor Kiss, John Moppett, Bela Patel, Heike Pfeifer, Carmelo Rizzari, Josep-Maria Ribera, Susana Rives, Anke Schilhabel, Lewis B. Silverman, Nicholas J Short, David T. Teachey, Toby N Trahair, Vincent H.J. van der Velden, Kerry Wall, Jacques J.M. van Dongen, Jan Zuna, Nicolas Boissel, Martin Schrappe, Monika Brüggemann
Institutions: University Hospital Schleswig-Holstein, University of Padua, Centre for Biomedical Network Research on Rare Diseases, Institut de Recerca Sant Joan de Déu, University of Milano-Bicocca, Sapienza University of Rome, Hôpital Armand-Trousseau, Tata Medical Center, University of Turin, Charité – Universitätsmedizin Berlin, St. Jude Children's Research Hospital, University of York, Hull York Medical School, Charles University, Goethe University Frankfurt, University Hospital Frankfurt, Children's Cancer Institute Australia, University of Debrecen, Bristol Royal Hospital for Children, Queen Mary University of London, Universitat Autònoma de Barcelona, Josep Carreras Leukaemia Research Institute, Hospital Universitari Germans Trias i Pujol, Hospital Sant Joan de Déu Barcelona, Christian-Albrechts-Universität zu Kiel, Columbia University Irving Medical Center, The University of Texas MD Anderson Cancer Center, Children's Hospital of Philadelphia, Sydney Children's Hospital, Erasmus MC, Birmingham Women’s and Children’s NHS Foundation Trust, Assistance Publique – Hôpitaux de Paris, Hôpital Saint-Louis
Language: English
Subfield: Hematology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $5,500
OpenAlex ID: W7225744340
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