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What Does MRD Mean for ALL Patients?

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Published on February 27, 2020

Key Takeaways

“Remission rates using traditional methods like microscopy are very high in ALL, but we know many people do not stay in remission long-term,” says Dr. Ryan Cassaday, explaining why MRD testing and its ability to detect small amounts of residual disease is significantly more accurate than other methods in determining the effectiveness of a treatment and predicting how likely a patient is to stay in remission.

In this video, Dr. Cassaday, an acute lymphoblastic leukemia expert from the University of Washington School of Medicine, discusses MRD testing with Patient Power Co-Founder Andrew Schorr, and explains the important role it plays in treating ALL. Watch now to learn more.

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Transcript | What Does MRD Mean for ALL Patients?

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Andrew Schorr:       

Minimal residual disease or measurable residual disease, MRD, you’ll talk about it in hematology. So, where does testing for that come in now to know how the medicine has worked?

Dr. Cassaday:           

Yeah. So, I would argue that MRD has the most established role in any heme malignancy or any malignancy in general as an ALL. So, MRD has been an understood marker of response and prognosis for many years, mostly in pediatric ALL. And a lot of that experience we’ve sort of borrowed or adapted to the adult experience.

So, the concept is essentially that using more sophisticated techniques than just a pathologist looking under a microscope we can detect disease that is still there after treatment has been delivered. And as I often tell patients, “Any amount of disease we can detect is a problem. It means we haven’t gotten rid of it.”

So, because remission rates using traditional methods like microscopy are very high in ALL, but we know many people do not stay in remission long-term, tools like flow cytometry or PCR or next-generation sequencing, some of the different techniques that are out there to look for these small amounts of residual disease, become really, really important to understand really how effective a treatment is and how likely a patient is to stay in remission.

Andrew Schorr:       

So, the bottom line on this is you have testing up front to see what version of ALL do you or your child or your loved one—what version do you have that you’re dealing with? And then as you’ve done treatment you can look with this MRD testing and say, “How well have we done, do we need more, or are you in such a deep remission, go on with your life for a while?”

Dr. Cassaday:           

Yeah. To a certain extent that’s true. I think one of the challenges though is—depending on how sensitive the method you’re using to detect ALL, you could potentially be falsely reassured that we’re not seeing any disease. And I tell patients this a lot. 

I’m very careful when I talk to patients about the results of these. I try to say things like, “Your disease is undetectable.” I try not to say, “There’s no disease.” Because if you truly had no disease, you’d be cured, and we wouldn’t need to give you anymore treatment.  But the reality is, a fairly significant proportion of people will become MRD-negative, meaning no detectable disease, within a few weeks of starting treatment for ALL. But a standard course of treatment for ALL can last for three years in some cases. 

So, we don’t necessarily stop treatment because we’ve achieved that threshold. We recognize that there’s probably still disease there, we just can’t detect it. And if we stop treatment prematurely, that might give the disease a chance to come back. And then it’s really difficult to treat. 

Andrew Schorr:       

Okay. But the good news—and I’m a chronic lymphocytic leukemia or lymphoblastic leukemia patient having MRD testing. I’d at least like to know that what I’ve been getting has been effective. And you’re right, you may need it for longer based on what all your research studies show in your clinical trials, but it’s sort of a report card, I feel.

Dr. Cassaday:           

That’s certainly a good way to put it. And I think it’s—it affirms just how effective a treatment that you’ve been getting was. To see that result come back and to know even at a level of 1 in 100,000 or 1 in 1,000,000 cells we can’t find any leukemia, that’s great. It also provides some sobering truth that even though on a superficial level it might look like a treatment was very effective, if we can still detect any disease, particularly a fair bit into the start of that treatment, it likely means that if we keep doing that treatment, the disease—the little bit that’s still there is resistant. It’s likely going to break through and cause an overt relapse and then a lot of problems.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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