Using MRD to Predict Outcomes in Acute Myeloid Leukemia

Measurable residual disease (MRD) in acute myeloid leukemia (AML) is measured through flow cytometry or molecular testing that specifically treats subgroups like FLT3 mutations. MRD is a powerful tool to predict long-term outcomes in patients with AML as well as detect early relapse before it becomes morphologically evident. If MRD levels rise, even slightly, it may indicate a potential relapse. While intervention is not immediate for molecular relapse, MRD is monitored closely.

Here, Sangeetha Venugopal, MD, MS, physician in the Department of Medicine, Division of Hematology, at the Sylvester Comprehensive Cancer Center at the University of Miami, discusses how MRD is used in the course of AML treatment.

Transcription:

0:05 | We measure the residual disease by 2 ways. One is through flow cytometry, and the other one is specific testing for molecular subgroups. So the only specific testing that is approved to treat approved for MRD is for FLT3, because looking at the measurable residual disease, we want to look at a deeper level than the morphology and the pulse sequencing. So the measurable residual disease needs depth of at least 10^-5 five. So we look at measurable disease in a few subgroups. One is core binding factor. And for FLT3-mutated AML and for all AML that is using flow cytometry, we look at the measurable residual disease.

0:54 | The reason why we are looking at measurable residual disease is because it predicts long-term outcomes in a patient with AML. For example, in a patient with core binding factor leukemia, if we track the measurable residual disease by, especially for the inv(16) and t(8;21) translocation, and when we track it, we can actually find if, at some point, if they lose that response. For example, all along it is negative, and suddenly we see something like popping up, which is positive, even though it is low-level positive. Then we increase the frequency to see if we can intervene before there is a frank morphological relapse. Right now, we do not intervene if it is just molecular relapse; however, we monitor the MRD more frequently than usual if we see that the level of MRD is rising.