For example, in AML, the presence of an aberrant phenotype highlighted using the markers CD and CD2, can be used to mark the presence of leukemic cells at diagnosis and through the chemotherapeutic regimen, as well as identifying a phenotypically identical relapse. Moreover, flow cytometry analysis to detect MRD can be used in the post-transplant setting using the markers CD56 and CD13, which illustrates how MRD guided treatment can allow for remission following relapse. Professor Ossenkoppele highlighted the results from two prospective trials which showed that in patients who were MRD negative following chemotherapy, the incidence of relapse was lower compared to patients who were MRD positive at each stage tested, both in younger and older patients.
Moreover, Professor Ossenkoppele illustrated that the trend in the literature suggests that for patients with MRD negative status, there is a greater estimated median survival time compared to patients with MRD positive status. Professor Ossenkoppele discussed whether MRD guided therapy could benefit patients with AML, highlighting a benefit in high- and low-risk patients. A major challenge is still present within the current diagnostic tools, with current methods to assess MRD proving insufficient.
Mayo Clinic Laboratories | Hematology Catalog
A combination of technologies provides the enhanced opportunity to identify and classify patients according to disease status, with next-generation sequencing and flow cytometry both highlighting significant association with AML relapse. To summarize, the ELN recommendations for MRD assessment include analysis pre-transplant and post-transplant, with clinical trials requiring further testing.
Moreover, in all clinical trials, MRD should be assessed, with the value of MRD in terms of clinical outcomes requiring further investigation in randomized trials. Inaba H. Comparative analysis of different approaches to measure treatment response in acute myeloid leukemia. J Clin Oncol.
Minimal residual disease in acute lymphoblastic leukemia.
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Renal Cell Carcinoma. Skin Cancers. Thyroid Cancers. Dialogues in Diagnostics. Differential Diagnosis. Case-Based Peer Perspectives. Email Sign-Up. Propelled by strong results in clinical trials, minimal residual disease MRD has emerged as a biomarker for directing treatment and as a predictor for outcomes in patients with acute lymphoblastic leukemia ALL and acute myeloid leukemia AML.
MRD Emerging as a Biomarker in Acute Leukemia
This test is used to establish an antigen footprint of tumor cells at diagnosis to monitor minimal residual disease in these patients after treatments or transplants. This test will be processed as a laboratory consultation.
An interpretation of the immunophenotypic findings and correlation with the morphologic features will be provided by a hematopathologist for every case. This test is only appropriate for patients who have a previous confirmed diagnosis of B-cell lymphoblastic leukemia.
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Treatment with antibodies to CD19 may interfere with the ability to detect minimal residual disease MRD. Thirty-three patient samples were analyzed with 14 of these showing no measurable minimal residual disease MRD. Six of these had 2.
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The 4 with the lowest percent MRD involvement were 0. J Clin Oncol ; Clinical significance of minimal residual disease in childhood acute lymphoblastic leukemia and its relationship to other prognostic factors: A Children's Oncology Group study. Blood ; Borowitz MJ, Pullen DJ, Winick N, et al: Comparison of diagnostic and relapse flow cytometry phenotypes in childhood acute lymphoblastic leukemia: implications for residual disease detection: a report from the children's oncology group.
Cytometry B Clin Cytom ; Campana D: Role of minimal residual disease monitoring in adult and pediatric acute lymphoblastic leukemia. Hematol Oncol Clin North Am ; Am J Clin Pathol ; Coustan-Smith E, Ribeiro RC, Stow P, et al: A simplified flow cytometric assay identifies children with acute lymphoblastic leukemia who have a superior clinical outcome.
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