Dr Daver on the Potential Role of MRD Assessment in AML Treatment

Naval G. Daver, MD, professor, director, Leukemia Research Alliance Program, Department of Leukemia, Division of Cancer Medicine, The University of MD Anderson Cancer Center, discusses the potential role of minimal residual disease (MRD) assessments in acute myeloid leukemia (AML).

The future of MRD in AML may follow a path similar to that seen in multiple myeloma, where MRD has become a key regulatory marker, Daver begins. However, establishing MRD as a reliable indicator for treatment outcomes and overall survival (OS) in AML necessitates a series of prospective, randomized studies with consistent MRD monitoring, he states. One significant challenge in AML has been the type of MRD assessment used, which differs from the more established flow cytometry techniques employed in chronic lymphocytic leukemia, multiple myeloma, and acute lymphoblastic leukemia, according to Daver. Flow cytometry, although effective and sensitive in experienced labs, requires fresh samples and a baseline bone marrow assessment for comparison, making it less feasible for large-scale, multicenter studies, Daver explains.

In response to these challenges, research focus has shifted in recent years toward molecular next-generation sequencing (NGS), particularly for markers like FLT3, NPM1, and KMT2A rearrangements, among others, he continues. Emerging data from both retrospective and prospective studies indicate that these molecular markers are strongly associated with event-free survival and OS, Daver states. Unlike flow cytometry, NGS can be conducted on stored samples, allowing for implementation in international randomized trials, and it does not require a baseline bone marrow sample for comparison, Daver emphasizes. This makes NGS an attractive option for future research and clinical applications, he says.

Looking ahead, MRD assessments could play a significant role in academic research, regulatory approvals, and clinical decision-making, he expands. For instance, MRD might help determine which patients with AML need maintenance therapy post-transplant or which might require a transplant in the first remission, Daver explains. Although widespread implementation of MRD assessments is still a few years away, ongoing studies are likely to provide the necessary data to support MRD as a regulatory marker in AML, Daver concludes.