Advancing the Minimal Residual Disease Concept in Acute Myeloid Leukemia
Peter Hokland1, Hans B Ommen1, Matthew P Mulé2
1Department of Hematology, Aarhus University Hospital, Denmark.
Abstract:
The criteria to evaluate response to treatment in acute myeloid leukemia (AML) have changed little in the past 60 years. It is now possible to use higher sensitivity tools to measure residual disease burden in AML. Such minimal or measurable residual disease (MRD) measurements provide a deeper understanding of current patient status and allow stratification for risk of subsequent clinical relapse. Despite these obvious advantages, and after over a decade of laboratory investigation and preclinical validation, MRD measurements are not currently routinely used for clinical decision-making or drug development in non-acute promyelocytic leukemia (non-APL) AML. We review here some potential constraints that may have delayed adoption, including a natural hesitancy of end users, economic impact concerns, misperceptions regarding the meaning of and need for assay sensitivity, the lack of one single MRD solution for all AML patients, and finally the need to involve patients in decision-making based on such correlates. It is our opinion that none of these issues represent insurmountable barriers and our hope is that by providing potential solutions we can help map a path forward to a future where our patients will be offered personalized treatment plans based on the amount of AML they have left remaining to treat.
Insights
Minimal residual disease (MRD) monitoring in acute myeloid leukemia (AML) offers deeper insights into patient status and relapse risk. Overcoming barriers to routine MRD use can enable personalized AML treatment plans.
Area of Science:
- Hematology
- Oncology
- Molecular Diagnostics
Background:
- Current acute myeloid leukemia (AML) treatment response criteria are outdated.
- High-sensitivity tools for minimal residual disease (MRD) detection are now available.
- MRD measurements offer deeper patient status understanding and relapse risk stratification.
Purpose of the Study:
- To review constraints hindering routine clinical adoption of MRD measurements in non-acute promyelocytic leukemia (non-APL) AML.
- To propose solutions for overcoming these barriers and facilitating personalized treatment decisions.
Main Methods:
- Review of existing literature and clinical practices regarding MRD in AML.
- Analysis of potential obstacles to MRD assay implementation.
- Discussion of strategies for patient-centered decision-making.
Main Results:
- Despite a decade of validation, MRD is not routinely used in non-APL AML clinical decision-making or drug development.
- Identified constraints include user hesitancy, economic concerns, assay sensitivity misperceptions, lack of a universal solution, and patient involvement.
Conclusions:
- Identified barriers to MRD adoption in AML are not insurmountable.
- Implementing solutions can lead to personalized treatment plans based on residual disease burden.
- The future of AML management involves integrating MRD data for optimized patient care.
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