Integrated Genetics and MRD Guide Transplant in Ph-Negative ALL

The management of adult Philadelphia chromosome-negative acute lymphoblastic leukemia has shifted toward pediatric-inspired protocols that emphasize intensive induction and risk-adapted consolidation [1, 2]. While achieving measurable residual disease negativity is a primary driver of long-term survival, relying solely on early molecular response may overlook patients with high-risk genetic profiles who remain prone to late relapse [3, 4]. Recent advances in immunotherapy, such as the bispecific T-cell engager blinatumomab, have improved outcomes by inducing deeper remissions, yet the optimal criteria for transitioning patients to allogeneic hematopoietic stem cell transplantation remain debated [5, 6]. Clinicians must balance the curative potential of transplantation against significant treatment-related mortality, particularly in older adults [7, 8]. A prospective study now evaluates an integrated model that combines centralized genetic assessment with early measurable residual disease kinetics to refine therapy allocation, offering a clearer roadmap for deciding which patients truly need a transplant.