SOHO State of the Art Updates and Next Questions: Measurable Residual Disease in Acute Lymphoblastic Leukemia - Optimization and Innovation in 2022 and Beyond

In this article, the authors review the use of measurable residual disease in acute lymphoblastic leukemia. Topics include the increasing sensitivity of MRD detection, MRD surveillance, peripheral blood vs. bone marrow assessments, and CNS analysis. Measurable residual disease (MRD) is an established component of acute lymphoblastic leukemia (ALL) management in both children and adults. Society guidelines and expert consensus documents include assessment of MRD as the standard of care following induction therapy, consolidation therapy, and at additional time points, depending on the treatment regimen administered. Further, the approval of blinatumomab for MRD+ B-ALL has advanced the concept of MRD response as a clinical endpoint in ALL. Although the utility of MRD in ALL has been well defined over the last decades, several questions remain. In this review we focus on areas of ongoing controversy and exploration in ALL MRD, including the following: (1) Does increasing the depth of MRD assessment add prognostic value? (2) Is there a role for ongoing MRD monitoring once patients achieve MRD response? (3) Can MRD assessment of the peripheral blood be substituted for bone marrow? (4) Should MRD assays be applied to the analysis of the central nervous system (CNS)? Ongoing studies should answer the majority of these questions in the coming years.

Automated summary

In this article, the authors review the use of measurable residual disease (MRD) in acute lymphoblastic leukemia (ALL). They discuss the increasing sensitivity of MRD detection, MRD surveillance, peripheral blood vs. bone marrow assessments, and CNS analysis. The utility of MRD in ALL has been well defined, but there are still some ongoing controversies and questions that need to be addressed in future studies.