Emerging technologies for minimal residual disease detection in hematologic malignancies

Minimal residual disease (MRD) detection plays a critical role in determining prognosis, guiding therapy, and monitoring relapse in hematologic malignancies. Current gold-standard assays rely on flow cytometry, polymerase chain reaction (PCR), and next-generation sequencing (NGS) performed on bone marrow aspirates. While highly sensitive, these methods rely on invasive bone marrow sampling, which limits assessment frequency and restricts evaluation to a single anatomic site, potentially missing spatially heterogeneous or extramedullary disease. Emerging plasma-based and imaging approaches promise broader, more frequent, and less invasive surveillance. This review discusses the principles and clinical readiness of both conventional and emerging MRD assays, describing how these approaches can improve disease monitoring and therapeutic decision-making.