Microlearning As a Tool to Enhance Treatment of Acute Lymphoblastic Leukemia: Outcomes from a Focused Educational Intervention on MRD-Guided Therapy in B-ALL
Authors: Deluca Carmine , Short Nicholas J. , Beyer Michael , Corti Andrea , Massey Jessica 
Published: December 2024

Background: The prognostic power of assessing measurable residual disease (MRD) has prompted a reassessment of goals of care in the management of acute lymphoblastic leukemia (ALL), leading to the validation of high-sensitivity testing platforms alongside the expanded use of antibody platforms to accurately detect MRD status and personalize treatment (Short NJ, et al. Am J Hematol. 2019;94(2):257-265.) Although incorporating newer therapeutics into treatment protocols for adult ALL has improved outcomes in recent decades, real-world treatment patterns have highlighted the uneven use of MRD assessment, persistent undertreatment, and substantial heterogeneity in the integration of modern therapeutics into care (Deeren D, et al. Leuk Res. 2020;91:106334; Shah S et al ASCO 2019. Abstract e18517.)

Methods: To address these gaps, PeerView developed an online educational initiative designed to provide maximum engagement and retention for learners. The education was delivered within a series of microlearning modules framed by pre- and post-assessment questions, with each segment designed to build on the prior module to provide a coherent, linked educational experience. Program objectives were designed to improve learner knowledge of evidence supporting MRD assessment as a component of modern ALL therapy, including when using antibody-based strategies, and enhance learner skills in delivering MRD-guided therapy in the adult B-ALL setting. The program launched in May 2024 and was targeted to an audience largely comprising hematologist-oncologists involved in the care of patients with ALL. Learners' baseline proficiency was determined via assessment questions and stratified into ‘not proficient’, ‘approaching proficient’, and ‘proficient’ based on performance. Improvements in learners' knowledge of data supporting antibody therapy in ALL and skills for developing MRD-guided treatment were evaluated to measure the educational impact of the activity.

Results: Data were collected from a total of 168 hematologist-oncologists participating in the micro-learning activity. Pre-activity, 46% of these professionals exhibited limited awareness of current data informing the personalized treatment of adult ALL, while 50% of respondents demonstrated inadequate skills for selecting guideline-adherent therapy (such as consolidation with bispecific antibodies) personalized according to response to frontline induction regimens. Collectively, 46% of learners initiated the activity as ‘not proficient’, 43% as ‘approaching proficient’, and 11% as ‘proficient’ clinicians. ‘Not proficient’ scores were associated with community-based clinical settings, high patient loads (according to publicly available data related to use of ICD-10 diagnostic codes in 2023), and primary management relying on patient referral to tertiary centers. ‘Approaching proficient’ levels were also observed predominantly among community-based clinicians practicing at high-volume hospitals, but this cohort reported greater rates of involvement in primary oncologic management.

After completion of the educational activity, 74% were able to accurately identify key efficacy outcomes associated with the earlier, MRD-guided use of bispecific antibody therapy for adult ALL (p&lt;0.05), while 79% demonstrated improved skills for translating this evidence into MRD-guided treatment decisions (p&lt;0.05). The learning activity improved knowledge and skills among clinicians with lower levels of baseline performance, as 79% of ‘not proficient’ improved their proficiency rating to ‘approaching proficient’ (57%) and ‘proficient’ (22%) after participating.

Conclusions: Among hematologist-oncologist learners, education with a microlearning design and focus on elements of modern ALL care led to an improved understanding of evidence supporting the integration of antibody therapy in MRD-negative and -positive disease, while also improving skills necessary for delivery of MRD-guided care. Learner conviction in the quality of evidence supporting modern therapy likely induced a higher level of proficiency among clinicians treating adults with B-ALL, including within certain cohorts of clinicians treating high patient volumes and in need of continuing medical education.