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ASH 2021 | Assessing MRD in hematologic malignancies

Paolo Ghia, MD, Università Vita-Salute San Raffaele, Milan, Italy, discusses the use of measurable residual disease (MRD) testing across different hematologic malignancies in a real world setting. Whilst assessing MRD is invaluable in evaluating treatment efficacy in patients with multiple myeloma, MRD as an endpoint is less reliable in patients in with chronic lymphocytic leukemia (CLL). Prof. Ghia additionally highlights the use of next-generation sequencing (NGS) over existing techniques such as flow cytometry to optimize MRD monitoring. This interview took place at the 63rd ASH Annual Meeting and Exposition congress in Atlanta, GA.

Transcript (edited for clarity)

Yes, MRD, minimal residual disease assessment is becoming of prominent value in hematologic malignancies, but there is a gradient I would say, while in the acute leukemias is part of the algorithm to decide the therapy in patients, especially in the children but also moving to the adult setting. In multiple myeloma for example, it is definitely a prognostic factor and it might be used also to evaluate the efficacy and compare the efficacy of drugs in clinical trials...

Yes, MRD, minimal residual disease assessment is becoming of prominent value in hematologic malignancies, but there is a gradient I would say, while in the acute leukemias is part of the algorithm to decide the therapy in patients, especially in the children but also moving to the adult setting. In multiple myeloma for example, it is definitely a prognostic factor and it might be used also to evaluate the efficacy and compare the efficacy of drugs in clinical trials. In chronic lymphocytic leukemia it remains still of an experimental endpoint, which should be included in all clinical trials, but at the moment should not be used to modify the treatment or to make any decision in terms of treatment in our patients. And in all different diseases, MRD is assessed by flow cytometry or by digital PCR. But the future is definitely NGS next-generation sequencing because it is able to achieve a much deeper level of detection, being able to detect one cell out of one million leukocytes. But instead flow cytometry and digital PCR, are probably in between 10 to the minus four, one cell out 10,000 to 10 to the minus five, one out of 100,000.

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