Residual disease detection following therapy is an important prognostic variable in B‐lymphoblastic leukemia (B‐LL). Most flow cytometric strategies for detecting B cell malignancy utilize CD19 to identify B cells. With growing use of anti‐CD19 targeted therapies, alternative strategies are needed for residual disease detection. We describe an approach for residual disease detection in this setting.

A novel combination was designed using expression of CD22 or CD24 (without CD66b) for B cell detection in combination with markers aberrantly expressed in B‐LL (CD10, CD20, CD34, CD38, and CD45). The performance characteristics of this combination were evaluated and compared to a standard, validated B‐LL MRD assay using 10 known negative samples, 10 overtly positive samples, and 11 post‐therapy samples (prior therapy other than anti‐CD19 therapy). Subsequently, results from the first 100 samples on which the new tube was performed were reviewed.

The described combination performed well in the initial analysis of 31 samples with all negative and positive samples correctly classified. In positive samples, the percentage of abnormal cells correlated well between the standard and new assay. Evaluation of the first 100 samples demonstrated good performance with adequate detection of CD19‐positive and CD19‐negative B‐LL. Additionally, it was observed that patients receiving anti‐CD19 therapies demonstrate an increased proportion of CD19‐negative progenitors.

These preliminary findings describe a strategy that performs well for residual disease detection in B‐LL post anti‐CD19 therapy. Such alternative strategies will become more important as the use of targeted immunotherapies becomes more common. © 2016 International Clinical Cytometry Society