To see all protocols that comply with the WHO Essential Medicine List 

Minimal residual disease (MRD) is used to stratify patients into risk groups. Please refer to the indications and patient population section of each BFM 2000 protocol (and the overall treatment schema and flow diagram) to see which risk groups are to receive which protocols.

Definition of risk groups

Standard risk (SR) Medium risk (MR) High risk (HR) Very high risk (VHR)
  • Prednisolone good response on day 8 (blast count less than 1.0 x109/L in peripheral blood after 7 days of prednisolone).
  • Negative for t(9:22) and/or bcr-abl.
  • Negative for t(4:11) and/or MLL/AF4.
  • Complete remission on day 33 marrow biopsy.
  • Either precursor-B or T linage.
  • MRD must be negative on day 33 (time point 1) and at day 79 (time point 2), (day 1 of Protocol M), measured with at least 2 markers with a sensitivity of < 10-4. If highly sensitive markers are available (eg: sensitivity of 10-6), then these should be negative.
  • Prednisolone good response as for SR.
  • Negative for t(9:22) and/or bcr-abl.
  • Negative for t(4:11) and/or MLL/AF4.
  • Complete remission on day 33 marrow biopsy.
  • Either precursor-B or T linage
  • MRD criteria not fulfilled for standard risk, high risk, or very high risk, or not tested/no result.
  • MRD may be positive at one or both timepoints, but must be <10-3 at timepoint 2.
  • Prenisolone poor response (peripheral blood blast count > 1.0 x109/L on day 8).
  • Patient must also have WCC < 100 x109/L, not be T lineage or pro-B cell phenotype, negative for t(9:22)/bcr-abl and t(4:11)/MLL/AF4.
  • Day 15 bone marrow biopsy in complete remission.
  • Day 33 bone marrow biopsy in complete remission.
  • MRD: <10-3 at timepoint 2 or unknown.
  • MRD: > 10-3 at timepoint 2.
  • Prednisolone poor response and either T cell, pro-B, or WCC >100 x109/L.
  • Positive for t(9:22) or bcr-abl.
  • Positive for t(4:11) or MLL/AF4.
  • Day 15 marrow > 25% blasts and patient already identified as high risk.

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https://www.eviq.org.au/p/3056

20 Nov 2019