Matthew Zachary

22-Year Cancer Survivor
Founder/CEO, Stupid Cancer

“The understanding of risk and MRD testing can literally be the difference between life and death. This happens all too frequently and is a scenario that can be entirely avoided. MRD testing is the strongest predictor of relapse, and relapse is the strongest predictor of patient outcomes.”

MRD is trace levels of the disease itself

Its detection requires an assay that is sensitive and precise.2-4

MRD results can be used to guide patient management

Including to inform treatment selection.5-7

MRD status is highly predictive of patient outcomes

Because clinical relapse begins with molecular relapse.6,8-12

CML
(chronic myeloid leukemia)

Molecular monitoring is an essential element of clinical management in CML. Testing quantifies levels of the bcr-abl fusion protein, a mutation responsible for the majority of CML cases. These levels are used in the management of CML to help define optimal treatment response, predict treatment resistance, and guide the course of treatment.13,15,18,19

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AML
(acute myeloid leukemia)

Monitoring MRD is standard of care in acute promyelocytic leukemia, a subset of AML. MRD levels can be used to determine molecular remission, defined as the absence of a particular gene fusion (PML-RARα), and to monitor patients post consolidation.20,21

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MM
(multiple myeloma)

Studies in patients with MM have shown that MRD status is prognostic of clinical outcomes, inclusive of overall survival and progression-free survival, and may be used to inform treatment strategies.3,28,29 Furthermore, evidence supports the importance of deep MRD negativity in patients with MM, as deeper responses (below a 10−6 threshold) have been associated with improved clinical outcomes.30

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ALL
(acute lymphoblastic leukemia)

Studies in both adult and pediatric ALL have demonstrated a correlation between MRD status and patient outcomes, and MRD negativity has been shown to be associated with improved event-free survival and overall survival.31-36 Sensitive testing techniques are able to detect MRD in peripheral blood (PB) of patients with ALL, and a correlation has been demonstrated between MRD measured in bone marrow and PB, although disease burden is typically lower in PB than in bone marrow.37-39

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CLL
(chronic lymphocytic leukemia)

Studies in CLL have shown that MRD is highly prognostic of progression-free survival and overall survival. In fact, MRD in CLL may represent an endpoint that more accurately describes the depth of remission than an endpoint such as complete response.40-43 Sensitive testing techniques are able to detect MRD in peripheral blood of patients with CLL, and in most cases, results are comparable to those seen with bone marrow.44,45

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NHL
(non-Hodgkin’s lymphoma)

In addition to evidence supporting the value of MRD assessment in bone marrow, advances in molecular assessment of MRD now make it possible to test blood samples and detect cell-free tumor DNA.46 Cell-free tumor DNA levels have been shown to enable early prediction of relapse in patients with certain types of NHL (eg, diffuse large B-cell lymphoma), compared with traditional techniques such as imaging.46,47

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Dr Fonseca of the Mayo Clinic, Phoenix, AZ, discusses the recommended use of MRD testing in multiple myeloma.

MRD status can be predictive of patient outcomes and aid in the clinical management of several hematologic malignancies.3,6,9,42

References:
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