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Evidence to Improve Care

Minimal Residual Disease Evaluation in Childhood Acute Lymphoblastic Leukemia


Ontario Health Technology Advisory Committee Recommendation

The Ontario Health Technology Advisory Committee recommends publicly funding minimal residual disease evaluation for pediatric management of acute lymphoblastic leukemia.

Read the full OHTAC Recommendation report



Leukemia is a cancer of the blood cells, and acute lymphoblastic leukemia comprises nearly 80% of childhood leukemia cases.

Patients diagnosed with acute lymphoblastic leukemia receive treatment that is tailored according to their chance of suffering a relapse. Despite treatment advances in recent decades, nearly a quarter of all patients with acute lymphoblastic leukemia still suffer relapse after remission. Relapse is thought to result from residual leukemic cells that persist after treatment. This low level of leukemic cells is known as minimal residual disease.

Testing for minimal residual disease involves the detection of tiny amounts of cancer cells in the bone marrow. Depending on whether minimal residual disease is found and at what level, treatment might be adjusted to help children have the best outcomes possible.


Health Quality Ontario Reviews Minimal Residual Disease Evaluation in Childhood Acute Lymphoblastic Leukemia

Health Quality Ontario completed a health technology assessment to examine the relationship between minimal residual disease and chance of relapse, as well as the effect of using minimal residual disease tests to tailor treatment. Health Quality Ontario also worked with the Toronto Health Economics and Technology Assessment Collaborative to determine the costs of minimal residual disease testing and to assess the test’s value for money.


Minimal Residual Disease Evaluation in Childhood Acute Lymphoblastic Leukemia: A Clinical Evidence Review (PDF)
March 2016

Minimal Residual Disease Evaluation in Childhood Acute Lymphoblastic Leukemia: An Economic Analysis (PDF)
March 2016


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The Ministry of Health and Long-Term Care has accepted this recommendation.

The Ministry of Health and Long-Term Care has provided the following response: The Ministry provided one-time funding to select hospitals to support the establishment of minimal residual disease testing in Ontario.




Health Technology Assessment at Health Quality Ontario

As part of our core function to promote health care supported by the best available evidence, we use established scientific methods to analyze the evidence for a wide range of health interventions, including diagnostic tests, medical devices, interventional and surgical procedures, health care programs and models of care. These analyses are informed by input from a range of individuals, including patients and clinical experts. The Ontario Health Technology Advisory Committee (OHTAC) — a committee of the Health Quality Ontario board of directors — reviews the evidence and makes recommendations about whether health care interventions should be publicly funded or not. Draft recommendations are posted on the Health Quality Ontario website for feedback. Final recommendations are approved by our board of directors and then shared with the Ministry of Health and Long-Term Care. For more detailed information, visit our Evidence to Improve Care pages.



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