Diagnosis, prognostic factors, and assessment of ALL in adults: 2024 ELN recommendations from a European expert panel.

ABSTRACT: Working groups of the European LeukemiaNet have published several important consensus guidelines. Acute lymphoblastic leukemia (ALL) has many different clinical and biological subgroups and the knowledge on disease biology and therapeutic options is increasing exponentially. The European Working Group for Adult ALL has therefore summarized the current state of the art and provided comprehensive consensus recommendations for diagnostic approaches, biologic and clinical characterization, prognostic factors, and risk stratification as well as definitions of endpoints and outcomes. Aspects of treatment, management of subgroups and specific situations, aftercare, and supportive care are covered in a separate publication. The present recommendation intends to provide guidance for the initial management of adult patients with ALL and to define principles as a basis for future collaborative research.

Comparison of Real-time Quantitative Polymerase Chain Reaction and Eight-color Flow Cytometry in Assessment of Minimal Residual Disease in Adult Acute Lymphoblastic Leukemia.

BACKGROUND: Minimal residual disease (MRD) is an important prognostic maker in acute lymphoblastic leukemia (ALL). However, few data comparing the measurement of adult ALL MRD using different methods in daily practice are available. We conducted an analysis comparing the importance of flow cytometry (FCM) and real-time quantitative polymerase chain reaction (PCR) in the assessment of MRD in adult ALL. PATIENTS AND METHODS: Fifty-six consecutive adult patients with both Philadelphia-negative and -positive ALL treated according to an intensive protocol were enrolled in the study. Bone marrow samples were acquired on day 26 and during week 11 of treatment. MRD evaluation was performed using 8-color FCM and PCR of immunoglobulin or T-cell receptor gene clonal rearrangements and BCR-ABL1, KMT2A-AF4 and E2A-PBX1 fusion genes. RESULTS: On day 26, both FCM and PCR seemed to have good discrimination sensitivity for overall survival (P = .001 to .008) and progression-free survival (P = .03 to .04) prediction for both Philadelphia-positive and -negative cases. The most sensitive method in week 11 was PCR including all results > 0 considered to indicate MRD positivity (P = .002 for overall survival and P = .02 for progression-free survival). PCR with other cutoffs was not sufficiently sensitive in week 11. Moreover, no FCM+ samples were found in week 11. The subanalysis of the Philadelphia-negative patients showed similar results. CONCLUSION: Our analysis showed that both FCM and PCR MRD assessment methods are sensitive for survival prediction during induction. However, we believe FCM could not be sufficiently sensitive in later phases of treatment.

Chronic lymphocytic leukemia and focusing on epidemiology and management in everyday hematologic practice: recent data from the Czech Leukemia Study Group for Life (CELL).

PURPOSE: Currently, pathogenesis, new prognostic factors, or new therapy in chronic lymphocytic leukemia (CLL) are frequently discussed; however, up-to-date data concerning the incidence and the management of CLL in everyday hematologic practice are still missing. The aim of our study was to find out the accurate epidemiologic situation of CLL and the diagnostic and therapeutic preferences of hematologists in the preselect area: the South Moravian Region (1,127,718 inhabitants, white race). PATIENTS AND METHODS: The total number of 540 patients (median age at the time of diagnosis, 65 years; sex, 306 men and 234 women) who had been followed in 2008 were included in the analysis. RESULTS: In the years 2006 and 2007, the incidence of CLL was 5.8 and 6.2, respectively, per 100,000; the prevalence was 48 per 100,000. Chronic lymphocytic leukemia treatment was indicated in 194 patients (36%); 93 (17%) of them also underwent the second line of treatment. Of these 194 patients, 64 patients (33%) were given fludarabine-based regimens, and 74 patients (38%) received chlorambucil as a first line of treatment. Thirty patients were treated within clinical trials. Although the treatment was indicated in only one third of patients (36%), new prognostic factors were examined in > 50% of patients. CONCLUSION: The ascertained incidence of CLL in our region is higher than declared incidence in the past. Evidently, CLL became an often misdiagnosed and underreported disease.