Minimal residual disease (MRD) testing using flow cytometry is widely used in risk stratification and treatment planning in childhood B-precursor Acute lymphoid leukaemia (B-ALL) The use of flowcytometric results has an advantage over newer molecular techniques in that results can be obtained within hours of sample collection. The Children’s Oncology Group (COG) B-ALL MRD flow cytometry protocol has its origins in the United States in work published more than 20 years ago by the Wood and Borowitz laboratories, is supported by a large volume of clinical data and is the most significant predictor of outcomes in children and young adults with B-ALL.
Pathology Queensland has been collaborating with the COG working party for more than 10 years and in 2017 was accredited to perform the COG B-ALL MRD flow cytometry protocol along with RCH Melbourne. My talk will describe the laboratory experience of integrating the COG protocol into the laboratory’s well-established in-house B-ALL MRD flow protocol. Technical challenges, comparison with molecular methods and future directions will be discussed.
Recently, therapeutic agents target against the CD19 surface protein on B-ALL cells have been developed. As an effect of these therapies, residual or relapsed B-ALL may not express CD19 and has led to the development of a single tube panel for the detection of CD19 negative B-ALL cells, described by Cherian et al. 2018. The use of this panel in our laboratory will also discussed.