Answering your biggest question:
Now what?

Knowing whether you have measurable disease in your body may provide reassurance and may help inform your clinician of steps to take next.1-7

Measurable residual disease (MRD) describes the cancer cells that may remain in your body after treatment. MRD testing that is highly sensitive can show whether many cancer cells or just a few remain.6,8-10

Knowing how much cancer is left can help your doctor monitor your condition and make treatment decisions.1,3,5,11 In some cases, the goal may be to eliminate all MRD.12,13 An MRD-negative result (meaning no remaining disease was found) depends on (1) the sensitivity of the test used to identify MRD and on (2) the quality and quantity of cells in the sample your doctor sends for testing.9,14

The insights and value
provided by MRD testing

Reliable and precise MRD testing can give your doctor confidence in predicting and measuring your response to treatment. It can also help your doctor monitor your remission. And even when you don’t have symptoms, it may identify early return of disease.1,5,6,9,15-17

By performing MRD testing, your doctor may be able to gain insights into your personal disease and how well it may respond to treatment.3-5

MRD is an important tool in the management of blood cancers.2,7,10,19-21

Blood cancers generally affect either myeloid or lymphoid cells. If you have questions about the type of blood cancer you have, speak with your doctor.

Blood cancers commonly affect B cells and T cells. In blood cancers, tests for MRD look for markers specific to patients and the type of cancer. Knowing your MRD status could help. You and your doctor can use it to track your disease and to make timely decisions personalized to your treatment.9,14,21-26

Get information on MRD in blood cancers: multiple myeloma, ALL, CLL, DLBCL, MCL

Advanced tools are available to assess MRD

The more sensitive and accurate a tool is, the greater the insights it may be able to provide.27,28

A variety of tests can be used to measure how much cancer you may have in your body before, during, and after treatment. The more sensitive a test is, the better it is at finding even just a few cancer cells among many normal ones.6,9,27,28

Each of these factors is important when considering MRD assessment tools24,29-33:

Sensitivity

Can it find a needle in a haystack?

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More sensitive tests can detect 1 cancer cell in 1,000,000 cells.34

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Accuracy

Is it good at telling the difference between a healthy cell and a cancer cell?

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Tests should provide clear and reliable results and should minimize false positives or false negatives.32

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Testing Experience

What kind of toll does it take—emotionally, physically, financially?

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You may want to consider the amount of bone marrow or blood required for testing, the wait time for test results, and whether insurance covers the test.29,31

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Consistency

Is it a tool that anyone can use and get the same results?

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The test can be used and understood regardless of the testing location or who performs it.

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Physicians can use a variety of techniques to measure MRD.

Light microscopy14,22,30,35

Earliest tool to measure disease

  • Sensitivity: Can range from 1 cancer cell in a sample of 20 cells checked to 1 cancer cell in a sample of 100 cells checked.
  • Still used during diagnosis and as a primary screening tool during treatment.
  • May not detect that the cancer has returned if there are no signs of it.

Flow cytometry20,27,31,36-39

Began in the 1980s

  • Sensitivity: Can range from 5 cancer cells in a sample of 1,000 cells checked to 1 cancer cell in a sample of 100,000 cells checked with next-generation flow.
  • Sample: At least 10 million cells for maximum sensitivity; must be fresh.
  • Results: In less than 1 day.
  • Consistency: Usually performed locally or sent to a third-party testing lab.

PCR-based (ASO-PCR) MRD detection14,36,40-42

Began in the 1980s

  • Sensitivity: Can range from 5 cancer cells in a sample of 100,000 cells checked to 1 cancer cell in a sample of 1,000,000 cells checked.
  • Sample: At least 2 million cells for maximum sensitivity; fresh or stored.
  • Results: Typically 4 to 5 weeks.
  • Consistency: Individual to each patient.

Next-generation sequencing
(NGS)27,31,34,43,44

Began in the 2000s

  • Sensitivity: 1 cancer cell in 1,000,000 cells checked.
  • Sample: At least 1 million cells; fresh or stored.
  • Results: Typically 1 week.
  • Consistency: Usually sent to a lab that specializes in this testing.

Not all tests perform equally,6 so talk with your doctor about your MRD testing options.

Your doctor will consider several factors in choosing the MRD test that’s right for you.

View or download the PDF “Questions to ask” for help talking with your doctor about MRD

MRD results may inform your treatment plan1-5,11

When MRD results are considered along with knowledge of your specific case, they can provide a very detailed understanding of your current disease level. This personalized information can help you and your doctor identify the appropriate steps to take next—from treatment options to the intensity and duration of therapy.3,5-7,15,19,27

Explore these resources that can help:

Multiple myeloma

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Multiple myeloma is a cancer of plasma cells, a type of white blood cell that produces antibodies.45-47

Understanding MRD in multiple myeloma

In multiple myeloma, MRD status is used to monitor how well treatment works and predict clinical outcomes; it also may help guide treatment decisions.2,5,48,49 MRD testing establishes categories of treatment response. In fact, clinical trials for a novel antibody therapy included MRD-negative results in the measure of how well treatment worked.50,51

  • MRD predicted treatment outcomes better than traditional assessments. This was true even when differences among patients were considered, such as the type of multiple myeloma and whether a transplant was completed.42
  • Studies have shown that patients who achieve an MRD-negative status after treatment live longer without their disease progressing.2,28,52

Acute lymphoblastic leukemia (ALL)

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ALL is an aggressive, fast-growing type of leukemia. In this disease, immature white blood cells (lymphoblasts) build up in the bone marrow and blood.47,53

Understanding MRD in ALL

Studies in both adult and pediatric ALL have demonstrated a link between MRD status and patient outcomes.31,54-59 In fact, the FDA (Food and Drug Administration) recently expanded its approval of a targeted therapy to make it the first drug approved for patients with MRD-positive ALL.11,60,61

  • MRD testing is one of the best ways to predict treatment outcomes; it can help to determine an appropriate course of therapy.9
  • The presence of MRD has been shown to be a significant risk factor for relapse.62-64
  • Patients who are treated for ALL and who achieve an MRD-negative status have been shown to live longer without their disease returning.29

Chronic lymphocytic leukemia (CLL)

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CLL is a slow-growing type of leukemia. In this disease, immature white blood cells (lymphocytes) build up in the blood, bone marrow, and lymphatic tissues.47,65

Understanding MRD in CLL

In CLL, an MRD-negative status at the end of therapy predicts remission more accurately than a “complete response” (where blood and bone marrow appear normal).66 In the past, criteria for response in CLL included the presence of an enlarged spleen. Now, however, data have shown that having an enlarged spleen is not important to assessing response if a patient has an MRD-negative result.67

  • Patients who are treated for CLL and achieve an MRD-negative status have been shown to live longer without their disease progressing.68-70

Diffuse large B-cell lymphoma (DLBCL)

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DLBCL is the most common type of non-Hodgkin’s lymphoma. This disease grows fast and accounts for about 1 in 3 of the lymphomas that are diagnosed in the United States.71

Understanding MRD in DLBCL

Until recently, MRD wasn’t monitored in patients with DLBCL because tests that were available weren’t sensitive enough. However, new advances in molecular MRD testing have made it possible to detect and measure pieces of DNA that are specific to lymphoma.72

  • Patients who remained MRD positive were compared with those who were MRD negative. More patients who were MRD negative after treatment were shown to live for 5 years before their disease returned.73,74

Mantle cell lymphoma (MCL)

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MCL affects B cells. It is a fast-growing, rare subtype of non-Hodgkin’s lymphoma. MCL accounts for approximately 4% of lymphomas.75

Understanding MRD in MCL

Patients who are treated for MCL and achieve an MRD-negative status have been shown to live longer before their disease progresses. They also live longer (overall survival).74,76

Resources to help educate you about blood cancer management, including MRD testing

Explore these resources that can help:

  • inform you about your disease
  • prepare you for conversations with your doctor
  • provide support for you and loved ones
  • cover costs associated with MRD testing

The following organizations can help patients and their caregivers learn about blood cancers. They provide great resources as well as support from other patients.

All4Cure — A knowledge-sharing platform for patients, clinicians, and researchers with an initial focus on myeloma

American Society of Hematology (ASH) — An international society focused on advancing the understanding, diagnosis, treatment, and prevention of blood cancers

Children’s Oncology Group (COG) — National Cancer Institute–supported clinical trials group devoted exclusively to childhood and adolescent cancer research

Leukemia & Lymphoma Society (LLS) — A society dedicated to blood cancer research, patient support, and policy and advocacy

Lymphoma Research Foundation (LRF) — A lymphoma-focused health organization seeking to improve care through education, support services, and research investment

Multiple Myeloma Research Foundation (MMRF) — A research foundation focused on driving advancements in myeloma through data sharing

National Pediatric Cancer Foundation (NPCF) — Nonprofit organization focused on funding research for childhood cancer

National Comprehensive Cancer Network® (NCCN®) — A not-for-profit organization dedicated to improving the quality, effectiveness, and efficiency of cancer care

Patient Power — Information and online educational programs for cancer patients and survivors

St. Baldrick’s — A charity dedicated to funding childhood cancer research

Stupid Cancer — Nonprofit organization focused on empowering, supporting, and improving health outcomes for young adults with cancer

 

Search for current clinical trials for people with your type of blood cancer:

clinicaltrials.gov

Download our “Questions to ask” document for help with discussing MRD with your physician.

Questions to ask
Questions to ask

 

ALL, acute lymphoblastic leukemia; ASO-PCR, allele-specific oligonucleotide polymerase chain reaction; CLL, chronic lymphocytic leukemia; DLBCL, diffuse large B-cell lymphoma; FDA, Food and Drug Administration; MCL, mantle cell lymphoma; MM, multiple myeloma; MRD, measurable residual disease; PCR, polymerase chain reaction.

This content and its publisher or sponsor do not endorse the use of any particular treatment. The full instructions for use of any such therapy, including any limitations, should be reviewed by a healthcare provider.

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