What is the most appropriate next test to perform in terms of patient's management and prognosis?

D. All of the choices are reasonable; however, the single most important piece of informa-tion that will radically affect patient's management and prognosis is positivity for BCR-ABL transcript. Philadelphia positive ALL constitutes 20% to 30% of adult ALL cases and is a marker of high risk and poor prognosis. Incorporation of tyrosine kinase inhibitors into ALL treatment regimens is currently considered standard of care (Blood. 201 0;11 5(2):206, Blood. 1999;93( 11 ):3983, Blood. 1992;80( 12):2983, Blood. 2007;109(4):1408, J Clin Oneal. 20 1 0;28(22):3644, Br J Haematol. 2009;145(5):58 1).