Educational Resources Needed to Promote MRD Testing for Adults With ALL at Community Practices

While measurement of minimal residual disease (MRD) at the end of induction is an important prognostic factor in acute lymphoblastic leukemia (ALL), there is a gap in education among community oncology providers, according to an abstract presented at the Society of Hematologic Oncology 2019 Annual Meeting.

MRD is being used more frequently in academic centers or centers that practice stem transplantation to determine depth of response and make decisions among maintenance therapy strategies. However, the abstract noted that adult ALL is less commonly seen in community oncology practices, and these providers may need additional education on the benefits of MRD testing for adult patients with ALL.

The FDA approved the first test, Adaptive Biotechnologies’ clonoSeq, to detect MRD in patients with ALL on September 28, 2018.

An environmental scan by the Association of Community Cancer Centers (ACCC) noted potential gaps and barriers. The report found that testing is variable in the community with differences in the timing and type of MRD tests used. MRD testing can be done on bone marrow aspirates or on peripheral blood; however, ACCC recommends using bone marrow.

The ACCC initiative led to a 1-year project with an advisory board and the development of peer-to-peer learning resources. The resources were developed by faculty from academic and community cancer programs and were created for the purpose of educating cancer team members located across the United States.

The environmental scan identified 6 key areas for potential education content creation and delivery: initial diagnostic workup; shared decision making (SDM); MRD testing; patient access, cost, and reimbursement; side-effect management; and transitions in care.

Once identifying those 6 areas, an ACCC report highlighted areas of opportunity for each, such as:

• “Improve the use of appropriate testing to properly diagnose and risk-stratify patients with ALL both in newly diagnosed patients and in the relapsed and/or refractory setting” (initial diagnostic workup);
• “Identify patient education materials and other tools that may facilitate the SDM process” (SDM);
• “Educate cancer clinicians about ways to tailor treatment plans based on MRD test results” (MRD testing);
• “Educate cancer clinicians about ways to utilize existing resources and provide better psychosocial supportive care services for patients with cancer who are at risk for experiencing financial toxicity” (patient access, cost, and reimbursement);
• “Educate patients about proactively reporting symptoms of possible treatment-emergent adverse events” (side-effect management)
• “Implement tailored care coordination models based on existing resources in the community setting (transitions in care)

“The environmental scan identified several areas for directed educational content delivery, including the integration of MRD testing for adult patients with ALL in community oncology practice,” the authors of the abstract concluded. “The resources created represent comprehensive educational materials that are useful to both providers and patients.”

Reference

Dawkins M, Lucas L, Boehmer L. Exposing community oncology gaps: promoting MRD testing for adults with acute lymphoblastic leukemia. Clin Lymphoma Myeloma Leuk. 2019;19(suppl 1):S182.