ESH AL 2026 | Current limitations of MRD detection in ALL & the value of NGS techniques
Wendy Stock, MD, University of Chicago Medical Center, Chicago, IL, comments on the controversies and limitations of measurable residual disease (MRD) detection in acute lymphoblastic leukemia (ALL), highlighting differences between flow-based and next-generation sequencing (NGS)-based methods. This interview took place at the 5th How to Diagnose and Treat: Acute Leukemias meeting of the European School of Hematology (ESH AL) in Mandelieu-La Napoule, France.
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Transcript
I think the controversies are that it’s an outstanding biomarker if it’s able to be monitored. There are some patients who, for example, don’t have a detectable clone if we’re using NGS-based MRD methods. And so that’s a limitation. Flow-based MRD is usually informative in almost all patients, but it’s not as sensitive as the next-generation sequencing techniques...
I think the controversies are that it’s an outstanding biomarker if it’s able to be monitored. There are some patients who, for example, don’t have a detectable clone if we’re using NGS-based MRD methods. And so that’s a limitation. Flow-based MRD is usually informative in almost all patients, but it’s not as sensitive as the next-generation sequencing techniques. In addition, the NGS techniques have not yet been validated or completely approved for T-ALL. So in that setting, still the standard of care, I think, is flow-based MRD for T-ALL. I think in North America, probably in Europe as well, the standard for AML in general is NGS-based MRD detection, but that’s not always informative. It’s informative in the vast majority of cases, but you can’t always detect a clone. It’s also expensive and not universally available. I think in the early studies, there were some studies from the MD Anderson which suggested that patients with Ph-like ALL who are MRD negative still had poor outcomes. I think with NGS techniques now, if patients are truly MRD negative, we’re seeing that it’s probably quite a robust marker for a particular patient. It’s highly predictive of outcome, I think, for almost any subset of ALL, and I don’t know of one where it would not necessarily be predictive of outcome.
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