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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.




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