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The International Consortium on Acute Leukemia (ICAL) is an international network that seeks to improve the care of patients with acute leukemia.

ASH member and ICAL participant Dr. Lorena Lobo de Figueiredo-Pontes (Ribeirao Preto Medical School, University of Sao Paulo, Sao Paulo, Brazil) has been general ICAL coordinator since December 2019, and coordinator of ICAL flow cytometry studies since January 2017. Since her hematology fellowship and PhD studies, she has worked on the challenging search for additional targets to improve outcomes in acute myeloid leukemia (AML), in collaboration with previous mentor Dr. Eduardo Rego, who conceptualized and was the first coordinator of the ICAL studies. As an independent investigator, Dr. de Figueiredo-Pontes felt it was a natural progression of her clinical expertise and research focus to join and take part of the consortium. Here she talks about why the program is so critical for AML clinical practice in Brazil and discusses the consortium’s implications on capacity building for hematology in the region.

“Besides the overall high relapse rates in AML, in developing countries like Brazil, treatment outcomes are still significantly inferior to those reported in Europe and the United States. Delays in diagnosis, lack of laboratory assays to perform complete risk stratification, and higher mortality rates associated with infectious complications contribute to these poor outcomes.

“The clinical network in developing countries that has been developed by ICAL will lead to the standardization of methods for diagnosis and assessment of measurable residual disease (MRD), including cytogenetics and molecular and flow cytometry analysis, and uniform treatment protocols among hematology centers. This will result in optimized risk stratification to better define treatment strategies and improve clinical outcomes.

“Although MRD detection by flow cytometry is already being done as part of the study and with good applicability for most patients, implementing next-generation sequencing (NGS) as a universal method with very high sensitivity will substantially improve the molecular detection of residual leukemic cells considering the great genetic heterogeneity of AML. In addition, the inclusion of NGS will allow the implementation of an innovative protocol at my institution and provide training for our laboratory staff. This is not only for the purposes of the ICAL study, but for other hematology/oncology applications at a reference center in Brazil.

The support of the Torsten Haferlach Leukemia Diagnostics Foundation was essential for ICAL’s new aim of implementing MDR detection by NGS at the five Latin American hematology centers (Brazil, Peru, Chile, Uruguay, and Paraguay). With the support of Illumina, the Foundation has provided the iSeq 100 equipment as well as reagents needed for the sample run. With the additional collaboration of Dr. Peter Valk from Erasmus University Medical Center, who has contributed the European LeukemiaNet based NGS panel design and specific reagents, and who will provide staff training, we anticipate implementing the methodology to the study in the next few months.

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