Dr. Bociek on the Clinical Uncertainty of MRD Negativity in CLL

R. Gregory Bociek, MD, associate professor of internal medicine, Division of Oncology and Hematology, program director, Hematology/Oncology Fellowship Program, University of Nebraska Medical Center, discusses the clinical uncertainty of minimal residual disease (MRD) negativity in chronic lymphocytic leukemia (CLL).

The phase 2 CAPTIVATE trial demonstrated that the 1-year disease-free survival (DFS) ​rate in patients with CLL or small lymphocytic lymphoma who ​had undetectable MRD and received ibrutinib (Imbruvica) was not significantly different compared with the 1-year DFS rate in patients who received placebo.

Although the data provided proof of principle that MRD could have clinical implications for patients with CLL, the role of MRD negativity in terms of treatment selection for patients with CLL remains largely unknown, says Bociek.

For example, if a patient finishes 6 cycles of bendamustine plus rituximab (Rituxan) or a year of induction therapy with venetoclax (Venclexta) plus obinutuzumab (Gazyva), MRD testing can indicate whether the patient has residual disease but cannot inform whether the patient should remain on venetoclax, says Bociek. As such, prospective data are needed to answer the clinically relevant question of what MRD status means in terms of treatment selection, concludes Bociek.