Nicholas Short, MD Discusses MRD-Detection Assays and Blinatumomab for Patients With ALL

In an interview with CancerNetwork®, Nicholas J. Short, MD, of the University of Texas MD Anderson Cancer Center, discussed the current assays for minimal residual disease (MRD) detection, blinatumomab (Blincyto) treatment, and other implications of the findings from study 583 on next-generation sequencing-based MRD presented at the 2020 American Society of Hematology (ASH) Annual Meeting & Exposition.

Transcription:

I think broadly [the trial] shows that, as we expected, our current assays are not optimal. It’s very important to detect MRD for various reasons. One is just for prognostic significance and that’s what we showed here is that those patients who have persistent MRD obviously have a higher rate of relapse. Then the question is, “what do we do with this information?” One [thing to consider] is whether or not these patients should be considered for transplant. I think that’s a very reasonable question. We found that in the differential outcomes between MRD negative and MRD positive [disease] by this highly sensitive [next-generation sequencing] assay were particularly pronounced in those patients who didn’t go to transplant.

Blinatumomab, for example, is a highly effective drug for eradication of MRD. Studies have looked generally at—it’s approved for a level of 0.1%—much deeper levels of MRD than we can detect with this. And so, I think one question is, should we be using blinatumomab, even for these lower levels of MRD? I think that is likely the case. But you know, those studies will need to be done. And then ultimately, for these patients who [have a] very low risk of relapse, can we de-intensify therapy for them? That’s still an open question as well.