Measurable residual disease (MRD) is an adverse prognostic factor in adult acute lymphoblastic leukemia (ALL) patients undergoing hematopoietic cell transplantation (HCT). Next-generation sequencing (NGS) can detect MRD with a sensitivity of 10-6, but the prognostic value of NGS-based MRD in adult ALL patients undergoing HCT remains minimally studied. To evaluate the prognostic value of NGS-based MRD in adult ALL patients undergoing HCT. Patients with ALL aged ≥18 years old who underwent allogeneic HCT at Stanford University or Oregon Health & Science University between January 2014-April 2021 and who were evaluated for MRD using the NGS-based clonoSEQ assay were included in this study. MRD was assessed pre-HCT (MRDpre) and for up to 1 year post-HCT (MRDpost). Patients were followed for leukemia relapse and survival for up to 2 years post-HCT. 158 patients had a trackable clonotype for MRD monitoring. The cumulative incidence of relapse was increased at all levels of MRDpre, including in patients who had low MRDpre of <10-4 (HR 3.56, 95% CI, 1.39-9.15). In multivariable analysis, MRDpre level remained significantly prognostic; however, detectable MRDpost was the strongest predictor of relapse (HR 4.60, 95% CI, 3.01-7.02). In exploratory analyses limited to B-cell ALL patients, detection of post-HCT IgH MRD clonotypes, rather than non-IgH MRD clonotypes, were associated with relapse. In this analysis across two large transplant centers, we found that detection of MRD by NGS at a level of 10-6 offers significant prognostic value in adults with ALL undergoing HCT.
Breast cancer research has traditionally focused on biological females who identify as women. Less is known about the incidence of breast cancer in transgender populations who identify with a gender that does not correspond with their birth sex. There are data to suggest a potential link between hormone replacement therapy (HRT) and breast cancer in transgender patients. While there is a need for more robust studies in this area, current data suggest there is no increased risk in female-to-male transgender men, and a potential increased risk in male-to-female transgender women. These studies also suggest that transgender patients face significant disparities in care. Clinicians require improved education to understand the potential risks associated with HRT, standards of cancer screening for transgender patients, and proper sensitivity in communication with this patient population. This review examines the existing literature, outlines the current data on the potential risks associated with HRT, and provides a 3-pronged approach to communicate risk, screen, and diagnose breast cancer in transgender patient populations. Note: All authors contributed equally to this manuscript.
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