Future Developments: Measurable Residual Disease

Measurable (previously minimal) residual disease (MRD) detection in acute myeloid leukemia (AML) has progressed beyond being a recognized strong prognostic factor. MRD-risk stratification is now incorporated into many treatment schedules and there is ongoing evaluation of MRD-directed therapy. Evolving assay technology such as next-generation sequencing has resulted in an increased repertoire of potential molecular biomarkers for MRD but molecular MRD can be challenging in AML, particularly in older adults, due to the oligoclonal profile of leukemic and co-existing pre-leukemic progenitors. Evaluation of different MRD markers/assays has also extended to assessing the therapeutic efficacy of novel drugs. How MRD assessments pre- and post-transplant should guide the delivery of allogeneic transplant and peri-transplant interventions to reduce relapse remains a key question but recent studies contribute important additional information. This review will update on what has been happening in these different areas and consider prospects for the future use and interpretation of MRD in the setting of trials and routine clinical practice.