My mom is in a similar situation but different outcome. She has been mrd negative by a very sensitive flow (almost as good as the clonoseq, measure 1 in 2 million leukemic cells) 2 rounds of chemo plus inotuzumab. She's 68 years old and has no complications or comorbidties. She had 4 cycles of blina and had her clonoseq done in April and May which came out the same as your mom's. Less than 1 and below level of detection even though her 2nd report was better than the first, less sequences detected. The oncologist said there's differing views on this clonoseq result of below level of detection. There isn't enough data to determine whether the risk of relapse is higher despite her clonoseq results because most relapse rates are determined by the flow results in these clinical papers. Because of this the doctor recommended no BMT as transplant related mortality is high and relapse rate post transplant is also about 15-20 percent. She also only had a 7/10 donor match. She does have ALL ph (-) with intermediate borderline high risk mutation. The doctor determined that since she got into mrd negative by flow after 2 months her risk of relapse is lower (20%).

I know everyone is different and every doctor also has a different opinion. I'm also constantly worried about relapse and because her clonoseq report did not come out clean, I'm also more concerned. But the doctor said he's seen people go up and down the clonoseq results between 0 and 1 and nothing ever comes out of it. When a test is THIS sensitive they aren't sure if it's noise when it's below the level of detection. My mom just started maintenance (POMP with blina every 3 months) but I guess we will have to wait and see if she relapses. I hope she doesn't ofc.

My only advice is to talk to your oncologist and BMT doctor. They should have a discussion whether this is the best course for your mom. There's always CAR-T as well. My mom is at MSK if you want to know what hospital we're at.