iwAL 2025 | MRD assessment in AML: challenges and evolving clinical impact

We really would like MRD monitoring to solve our problems. That’s what we want. We want there to be a test that says yes, no, and then know what to do. And actually, that’s not the case at all currently. We have flow cytometry-based MRD, which is whimsical. And actually, in some recently presented data, a coin flip may do better sometimes, which is quite a stunning thing to say. But there are data from across multiple different centers that are good centers that literally one will say it’s there and one will say it isn’t. And I don’t know what the clinician is to do with that. I think that the trial coming out of the UK NCRI, which showed specifically that for patients with NPM1 and FLT3, there was a benefit for monitoring, but for the other subgroups actually with molecular monitoring, including by fusion transcripts, that there wasn’t an overall survival benefit. We hope that that wasn’t because of the monitoring, but rather because of the available salvage therapies. So I think right now, if you ask me across the world, should everybody have MRD monitoring all the time? No, there need to be validated assays. You need to know what is the performance of the assay at your center. And I do think that some of the trials that are ongoing currently, for example, things like the INTERCEPT trial in which we’re trying to have very carefully measured MRD-directed therapy will help us answer this. But I actually think that doctors should be quite careful at the moment about using commercial labs, especially in the U.S., repeating tests in a post-remission setting and acting on them by changing the planned management, I think it’s pretty nuanced. And I think we probably are, possibly, doing harm by changing managed therapy in patients who are having non-validated MRD assays that are being used in unclear tissue.

This transcript is AI-generated. While we strive for accuracy, please verify this copy with the video.