SOHO State of the Art Updates and NextQuestions | Measurable Residual Disease and Its Management in Adult Acute...

During the past 3 decades, numerous studies have investigated measurable residual disease (MRD) detection methodologies and the clinical significance of MRD in acute lymphoblastic leukemia (ALL). These studies have consistently demonstrated that MRD is the most powerful independent predictor of relapse and survival outcomes in ALL. As a result, MRD testing has become an integral component of routine ALL management, guiding risk stratification and treatment modifications. MRD is increasingly proposed as a surrogate endpoint to accelerate the evaluation and approval of novel therapies for ALL. For patients in remission, whether on maintenance therapy or off, MRD monitoring serves as a surveillance tool for early relapse detection. In this review, we summarize current MRD quantification techniques, the prognostic significance of MRD across various ALL subtypes, approaches to MRD-guided treatment adaptation, key unmet needs, and future directions in the application of MRD in ALL management.