EBMT 2018 | MRD testing in acute leukemias

Josep-Maria Ribera

Here, Josep-Maria Ribera, MD, PhD, of Germans Trias i Pujol University Hospital, Barcelona, Spain, discusses the potential of measurable residual disease (MRD) testing to determine treatment outcome in acute leukemias. From the 2018 European Society for Blood and Marrow Transplantation (EBMT) Annual Meeting in Lisbon, Portugal, Prof. Ribera describes the treatment options for patients who are MRD positive, including immunotherapy and stem cell transplantation, and the ideal times for MRD testing during the treatment pathway.

Transcript (edited for clarity):

If the patient is MRD positive, it does not mean that this patient is incurable, but we have to modify our therapy and especially, to direct our focus on therapy on stem cell transplantation and on immunological therapies. MRD positive means just a high likelihood of relapse, but not incurability.
MRD now is a crucial measurement for for management of acute leukemias. This is absolutely clear for acute lymphoblastic leukemia, and it’s clearer for acute myeloid leukemia as well. I think it’s a hot topic, and this will drive therapy for these diseases.
MRD after after initial therapy, it’s a crucial point, we have to assess early when the patient achieves complete remission, and if there is a good clearance of MRD at that time, the patient could have a good prognosis. So because the the probability of relapse is lower than if he has measurable MRD.
I am absolutely in favour of this, morphologic complete remission means that you cannot see leukemic cells by light microscope, but there is a high quantity of leukemia at that time so MRD quantifies more precisely the level of leukemia after remission. So I think that MRD should be the target point to assess response after therapy in ALL. The best time points for MRD measurement and for taking decisions after according to MRD values, are end of induction and end of consolidation. So these are the two crucial time points, after induction, to direct the intensity of the consolidation and after consolidation, to decide if the patient has to be immediately transplanted or not.

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