Achieving MRD negativity in AML: how important is this and how do we get there?

Area of Science:

• Hematology
• Oncology
• Molecular Diagnostics

Background:

• Measurable residual disease (MRD) detection in acute myeloid leukemia (AML) correlates with increased relapse rates and poorer survival.
• Current AML response criteria increasingly incorporate high-sensitivity MRD testing, recognizing it as a superior indicator of remission compared to conventional methods.

Purpose of the Study:

• To review the evolving role and diverse applications of MRD testing in AML.
• To highlight the challenges and ongoing efforts in harmonizing AML MRD testing methodologies and clinical interpretation.

Main Methods:

• Review of current literature and clinical practice guidelines regarding MRD detection in AML.
• Analysis of the implications of MRD testing across various clinical scenarios, including trial enrollment, treatment assignment, and drug development.

Main Results:

• High-sensitivity MRD testing identifies patients with a superior complete remission (CR) status.
• Established use cases for MRD testing include patient selection, early relapse detection, and drug efficacy assessment.
• Significant challenges remain in standardizing AML MRD testing and defining its precise clinical implications.

Conclusions:

• AML MRD testing is a critical tool for refining response assessment and guiding therapy, despite ongoing standardization needs.
• Further research and collaborative efforts are essential to establish robust evidence for widespread clinical implementation and regulatory acceptance of AML MRD testing.