Journal
CURRENT OPINION IN ONCOLOGY
Volume 22, Issue 6, Pages 656-663Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/CCO.0b013e32833ed831
Keywords
acute promyelocytic leukemia; leukemic aberrant phenotype; leukemic stem cell; multiparameter flow cytometry; nucleophosmin (NPM1); Wilms' tumor gene (WT1)
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Funding
- National Institute for Health Research (NIHR)
- Cancer Research UK
- Leukaemia & Lymphoma Research of Great Britain [08030]
- Guy's and St. Thomas' Charity
- MRD Workpackage (WP12) of the European LeukemiaNet
- Oxford Partnership Comprehensive Biomedical Research Centre
- NIHR Biomedical Research Centres
- Medical Research Council
- MRC Molecular Haematology Unit
- MRC [G1000729] Funding Source: UKRI
- Medical Research Council [G1000729, G1000801c] Funding Source: researchfish
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Purpose of review The last 15 years have witnessed significant improvements in technologies to detect minimal residual disease (MRD) in acute myeloid leukemia (AML). We review recent studies highlighting the potential for novel and standardized assays to provide independent prognostic information and develop more personalized treatment approaches. Recent findings Progress includes establishment of optimized real-time quantitative PCR (RQ-PCR) assays for WT1 (commonly overexpressed and a putative therapeutic target) and mutant NPM1 genes. Moreover, sequential MRD monitoring using an internationally standardized PML-RARA RQ-PCR assay has been successfully used to guide molecularly targeted therapy in acute promyelocytic leukemia (APL). There have also been significant advances in multiparameter flow cytometry (MFC) to detect MRD, with introduction of 6-10 color technology and improved understanding of the immunophenotype of leukemic stem cells. Summary Sensitive MRD detection using MFC and/or RQ-PCR has become feasible in virtually all AML patients. MRD monitoring is now considered a standard of care in APL. Recent studies provide a strong rationale for prospective trials investigating the merits of extending MRD detection to alter therapy and potentially improve outcome in other AML subtypes.
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