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What Does Minimal Residual Disease (MRD) Mean for AML Patients?

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Published on November 19, 2019

Key Takeaways

  • Understand minimal or measurable residendual disease (MRD).
  • Specialized tests are used to detect residual disease too small to see with the microscope.
  • Expertise in MRD is important when considering treatment decisions.  

What do minimal residual disease (MRD) tests detect in cancer patients? How do the results impact care? During this Ask the Expert segment, Dr. Gail Roboz explains what MRD status means for acute myeloid leukemia (AML) patients, when testing is recommended and its value in making future treatment decisions. Dr. Roboz also discusses how precise MRD test results are and the importance of seeking consultation from an AML specialist.

This program is sponsored by AbbVie, Inc., Genentech, Inc. and Adaptive Biotechnologies. These organizations have no editorial control. It is produced by Patient Power. Patient Power is solely responsible for program content.

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I followed your excellent program and have been fortunate to receive valuable information from your AML program with Dr. Pollyea.

— AML Care Partner

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Transcript |

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.

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.

Carol Preston:               

There’s been so much in the news lately, mainstream news, as well as medical news about MRD, which is minimal residual—I’m blanking.

Dr. Roboz:                   

Minimal residual disease.

Carol Preston:              

Yeah, and the question is I actually had a lot of questions about that, minimal residual disease. First of all, someone with AML, when does that testing come into play? And number two, could a patient have MRD not negative meaning no detectable cells and still have a good quality of life or is treatment an absolute must?

Dr. Roboz:                   

Okay. So, there’s a lot in there. Let me dial back for a second. The terminology originally started as minimal residual disease, MRD but there’s been a strong movement across the hematological malignancies to change that to measurable residual disease. And the reason is not a trivial one. Doctors and patients can blow off something that’s minimal. “Ah, it’s minimal. It’s not that important.” Measurable residual disease comes into play very strongly because we know that if you use standard looking under the microscope criteria for patients with AML; there are a lot of patients who will have achieved complete remission, normal blood counts, feel good, going to work but who actually relapse.

How is that possible if everything is good? If the counts are normal and you feel good and everything is fine why are you relapsing? The reason is because looking under the microscope is simply not good enough. It is not this century’s technology for looking for evidence of disease that can come back. And for those of us who live in New York, it’s the cockroach analogy. The roaches are meant and designed to stay alive. They’re good at it. They wiggle out from under chemotherapy and they are buried deeply enough into the bone marrow that you can’t see them under the microscope.

So, this is a controversial area in which both next-generation sequencing, flow cytometry and cytogenetic testing are being used to detect evidence of residual disease that is lower than what is seen under the microscope and to make treatment decisions on that basis. MRD is definitely a reason why being seen at an academic center, especially if you’re considering undergoing stem cell transplant which is always done at a major center is important because if you’re detecting residual disease; you may have a great quality of life. You may be running around feeling very good but your chances of relapsing are very high. And the decision tree has to be that, “Well, is a transplant possible? Is there more treatment that is possible that could eradicate that level of residual disease?” And these are complicated decisions that really require a center with some expertise in the whole area of MRD and how to measure it.

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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