In order to ensure optimal testing within appropriate turnaround times, the following sample pathways should be adhered to:-
Sample pathways
We recommend sending a dedicated, unprocessed sample directly to the MRD laboratory (see address below) to ensure adequate DNA is yielded for screening and to permit longitudinal testing. If clinical teams elect to send samples via their local SIHMDS for onward referral to the MRD laboratory, it is essential that this is agreed with the respective local SIHMDS.
Request form
A copy of our request form can be found following this link. At diagnosis, it is essential to include the following data to ensure timely turnaround of results: The sample time-point (e.g. diagnosis vs follow-up), blast count, cell lineage, presenting white cell count for peripheral blood diagnostic specimens.
Sample requirements at diagnosis and/or relapse (screening and target identification)
Please send a minimum of 3ml bone marrow aspirate in ACDA or EDTA and/or 2 x 6ml peripheral blood in EDTA. Bone marrow trephines fresh in saline can be accepted if the aspirate is a dry tap. If on occasion, a diagnosis of ALL is identified later and a fresh sample is no longer available, we request a minimum of 4 micrograms of DNA.
Screening and target identification is a time-consuming process and takes a minimum of 4 weeks to complete. Therefore, it is important to send samples as soon as a diagnosis of ALL is established. Sending diagnostic material at the same time as post-treatment follow up samples leads to unnecessary delay in testing and reporting.
Sample requirements at follow up time points (MRD measurement analysis)
Please send a minimum of 3ml bone marrow aspirate in ACDA or EDTA. Please note, peripheral blood samples cannot be used for MRD monitoring. Currently post-phase 2 time-points are being prioritised for rapid reporting. If there is a clinical urgency regarding a particular sample, please do not hesitate to contact the team.
Reporting
Reports will be emailed to an nhs.net account of the referring clinical teams and the local SIHMDS if appropriate details are provided on the request form. If additional copies of reports are required, please provide details on the request form. All results can also be viewed using the online results portal CyberLab. For new access please follow the link.
For any queries or feedback relating to the ALL MRD service please do not hesitate to contact the team using the details below;
Acute lymphoblastic leukaemia MRD Service
Part of Specialist Integrated Haematological Malignancy Diagnostic Service (SIHMDS)
3rd floor, Pathology and Pharmacy Building
Royal London Hospital
80 Newark Street, London, E1 2ES
Email: bartshealth.ALLMRD@nhs.net
Tel (Specimen Reception): 020 346 0630
Tel (Office): 020 3246 0142
Tel (Head of Service): 020 3246 0118
Clinical Lead: Dr Bela Wrench
Scientific Lead: Dr Shaun Bevan
Service Lead: Marianne Grantham
