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When to Test for MRD in AML Patients

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Published on June 15, 2020

What is measurable residual disease (MRD), and when should an acute myeloid leukemia (AML) patient be tested?
 
Watch as Dr. Thomas LeBlanc, an AML expert from Duke Cancer Institute, discusses the significance of MRD and the different ways to test for it. He also explains how these tests can help patients and doctors plan for next treatments.

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Transcript | When to Test for MRD in AML 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.

Dr. LeBlanc:

So MRD is a controversial topic. It stands for minimal residual disease, but actually increasingly many of us are referring to it as measurable residual disease, because it's really not minimal if you have some measurable cancer left. So measurable residual disease is a marker, basically that a person is more likely to have a relapse. And so, I do often do this testing and I recommend doing it. The challenge is that it is not standardized yet. So there are many different ways that you can test for MRD. You can use flow cytometry assays, but you have to use a really high sensitivity flow assay that gets you down to 10-4, or even maybe 10-5 in its detection threshold. We also can use PCR-based tests. So if a person has a mutation that's detectable, then you want to test for the presence of that as an MRD marker.

So, for example, patients who have the NPM1 or nucleophosmin-1 mutation you want to use a PCR-based test to look for that. We could also use other kinds of cytogenetic and molecular tests to look for MRD. So we could use FISH tests, or we can use the next-gen sequencing tests, the next-gen sequencing tests. They're pretty reasonably sensitive and those tests for a whole number of different mutations. So we often will use those. And typically, I am sending MRD testing at the time that I think the patient is probably in remission. So if I've given them a bunch of treatment, maybe it's high-dose intensive induction therapy, or maybe it's a number of cycles of low intensity therapy and I'm seeing their blood counts are recovering and they're looking pretty good. They're not requiring transfusion support. They're feeling better, and I'm doing a bone marrow biopsy to hopefully prove a complete remission, a morphologic remission, which basically means we see fewer than 5 percent blasts under the microscope.     

There might be very little disease there, or there might still be quite a bit. And that's where the measurable residual disease assays can kind of help us quantify that. The downside is that we really don't have much data showing that doing something different about the MRD results makes a long-term outcome kind of a difference, but some of that evidence is starting to emerge now. And so many of us consider the persistence of MRD as an indication that we should continue to aggressively treat the disease or that we should maybe talk more seriously about the possibility of a stem cell transplant in the first remission, because we know that MRD is a factor that increases the likelihood of a relapse in AML. And it is certainly very strongly correlated with reduced overall survival and earlier and more frequent relapses. It's certainly not a guarantee. But for this reason, I think it is a really important piece of information to have. It's just not entirely clear yet how we should do the testing and how to interpret it in all cases.

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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