Background: The MRD Monitoring Challenge in Pediatric ALL
Measurable residual disease (MRD) is a critical prognostic factor in pediatric acute lymphoblastic leukemia (ALL), guiding treatment intensification or de-escalation decisions. The current gold-standard methods rely on tracking immunoglobulin/T-cell receptor (IG/TCR) gene rearrangements. However, these approaches face significant limitations: they are technically complex, not universally informative (particularly in certain ALL subtypes), and can be confounded by ongoing VDJ recombination or the absence of rearrangements in some fusion-driven leukemias.
