Flow cytometric and molecular MRD in AML: current methods, clinical applications and challenges

Area of Science:

• Hematology
• Oncology
• Clinical Diagnostics

Background:

• Measurable residual disease (MRD) in acute myeloid leukemia (AML) offers prognostic insights beyond initial diagnosis.
• Monitoring MRD in patients in remission after induction therapy is crucial for personalized treatment.

Purpose of the Study:

• To review the clinical implementation of MRD detection in AML patients in remission.
• To discuss MRD's role in guiding consolidation treatment, including allogeneic stem cell transplantation decisions.
• To highlight challenges and future directions in MRD assessment.

Main Methods:

• Review of current clinical practices and literature on MRD detection in AML.
• Discussion of three primary MRD detection methods: multiparameter flow cytometry (MFC), polymerase chain reaction (PCR), and next-generation sequencing (NGS).
• Analysis of the prognostic value, strengths, and limitations of each MRD detection method.

Main Results:

• MRD assessment provides prognostic information that complements molecular risk classification.
• MRD monitoring can guide decisions on treatment intensification or de-intensification, including allogeneic stem cell transplantation.
• Evidence supports MRD's utility in selecting conditioning intensity, stem cell source, and pre-consolidation therapies.

Conclusions:

• Standardization and harmonization of MRD detection methods across laboratories remain a key challenge.
• Combining different MRD detection methods may leverage their respective strengths for improved clinical utility.
• Continued research and international collaboration are essential for optimizing MRD's role in AML management.