MRD Tailored Therapy in AML: What We Have Learned So Far

Area of Science:

• Hematology
• Oncology
• Clinical Diagnostics

Background:

• Acute myeloid leukemia (AML) is a complex disease with high relapse rates, necessitating accurate prognostic factors.
• Measurable residual disease (MRD) has emerged as a critical prognostic indicator in AML, influencing patient survival.
• Advances in MRD detection are vital for refining AML management strategies.

Purpose of the Study:

• To review the technical, biological, and clinical advancements in MRD assessment for AML.
• To highlight the current role and future potential of MRD in AML patient stratification and treatment selection.
• To discuss the standardization and optimization of MRD assays for reliable clinical application.

Main Methods:

• Multiparameter flow cytometry (MFC) is the predominant method for MRD detection due to widespread laboratory experience.
• Quantitative PCR and next-generation sequencing offer alternative molecular approaches with varying sensitivities and applicability.
• Combination of different MRD assessment techniques shows promise for enhanced prognostic value.

Main Results:

• MFC-based MRD is the most utilized method for assessing treatment response in AML.
• MRD status post-chemotherapy is a strong predictor of relapse and survival.
• MRD-guided treatment decisions, such as allogeneic stem cell transplantation, improve outcomes for intermediate-risk AML patients.

Conclusions:

• MRD assessment is indispensable for prognostic stratification and guiding post-remission therapy in AML.
• Ongoing research focuses on optimizing MRD assays and exploring novel applications, including guiding stem cell transplantation and monitoring treatment efficacy.
• Standardization and validation of MRD techniques are essential for their routine clinical integration and maximizing prognostic impact.