Summary Detection of minimal residual disease (MRD) after induction and consolidation therapy is highly predictive of outcome for childhood acute lymphoblastic leukaemia (ALL) and is used to identify patients at high risk of relapse in several current clinical trials. To evaluate the prognostic significance of MRD at other treatment phases, MRD was measured by real‐time quantitative polymerase chain reaction on a selected group of 108 patients enrolled on the Australian and New Zealand Children’s Cancer Study Group Study VII including 36 patients with a bone marrow or central nervous system relapse and 72 matched patients in first remission. MRD was prognostic of outcome at all five treatment phases tested: at day 15 (MRD ≥ 5 × 10−2, log rank P < 0·0001), day 35 (≥1 × 10−2, P = 0·0001), 4 months (≥5 × 10−4, P < 0·0001), 12 months (MRD ≥ 1 × 10−4, P = 0·006) and 24 months (MRD ≥ 1 × 10−4, P < 0·0001). Day 15 was the best early MRD time‐point to differentiate between patients with high, intermediate and low risk of relapse. MRD testing at 12 and particularly at 24 months, detected molecular relapses in some patients up to 6 months before clinical relapse. This raised the question of whether a strategy of late monitoring and salvage therapy will improve outcome.

Objectives: To describe the location of treatment, recruitment to clinical trials and outcomes for adolescents and young adults treated for cancer in Victoria. Design and setting: Retrospective review of all adolescents and young adults aged 10–24 years diagnosed with cancer between 1992 and 1996, identified from the Victorian Cancer Registry. Main outcome measures: Treatment regimen (clinical trial, treatment protocol or neither), compliance with treatment and 5‐year survival. Results: Questionnaires were completed for 576 of 665 eligible adolescents and young adults (87% response rate). Recruitment into clinical trials decreased with increasing age. Adolescents aged 10–19 years were more likely to be recruited to a clinical trial if treated at a paediatric hospital. For all cancers, 5‐year survival was similar across the age groups and was not influenced by the place of treatment. Only 1% of adolescents and young adults failed to complete planned therapy due to non‐compliance. Conclusions: Despite a similar incidence of cancer to that in younger children, adolescents and young adults with cancer are poorly recruited into clinical trials in Victoria. Establishment of a cancer resource network in Victoria may provide information to both paediatric and adult oncologists about currently available clinical trials.

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