Measurable Residual Disease (MRD) and Assessment Types

  • Patients who achieve a CR are still at risk for relapse, and this is influenced by the amount of measurable residual disease (MRD) present1
  • Patients who achieve a CR based on morphologic assessment alone can still have a large number of leukemic cells in the bone marrow2
  • The above image represents one reference’s definition of MRD; other references and/or institutions may vary in their definition1:
    • The lightest grey area of the figure represents microscopic disease detection. The colored lines appearing in this section represent disease that can be microscopically detected
    • The middle grey area refers to the proportion of leukemic cells classified as MRD. The lines that traverse this section of the plot represent disease that is at risk of relapse
    • The darkest grey area is the area of no disease detection (MRD-) and is associated with molecular complete response
  • There is no standardized test for MRD, but it is most commonly detected by MFC or RQ-PCR methods3
  • Thresholds of detection depend on type of assessment and subgroup of AML3
MFC, multicolor flow cytometry; NGS, next-generation sequencing; RQ-PCR, real-time quantitative polymerase chain reaction.

References: 1. Buckley SA, Appelbaum FR, Walter RB. Prognostic and therapeutic implications of minimal residual disease at the time of transplantation in acute leukemia. Bone Marrow Transplant. 2013;48(5):630-641. 2. Schuurhuis GJ, Heuser M, Freeman S, et al. Minimal/measurable residual disease in AML: a consensus document from the European LeukemiaNet MRD Working Party. Blood. 2018;131(12):1275-1291. 3. Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Acute Myeloid Leukemia V.3.2021. © National Comprehensive Cancer Network, Inc. 2021. All rights reserved. Accessed April 22, 2021. To view the most recent and complete version of the guideline, go online to NCCN.org. NCCN makes no warranties of any kind whatsoever regarding their content, use or application and disclaims any responsibility for their application or use in any way.