BSH 2024 | Should MRD eradication be the goal when treating every patient with CLL?

So MRD is an increasingly used tool for lots of diseases. In CLL, the therapies that we use aren’t curative, and so MRD is being used increasingly to try and predict for duration of response to therapy. So whether with certain treatments, the depth of the response correlates to the duration, how long someone remains in remission for. We’ve also seen trials in CLL where it’s been used to dictate the duration of therapy, so, how long someone stays on therapy for. But the way that MRD is being used is still very much in the research field rather than everyday clinical practice at the moment, but it is a very exciting area. 

I think it is very treatment-specific and disease-specific. So we know that there are certain treatments where patients are not going to achieve undetectable MRD, and so there’s not much point in testing. So, say for example, if you’re using a continuous BTK inhibitor, whereas there are other treatment regimens where it is very useful in terms of predicting the duration of therapy, such as the fixed-duration venetoclax-based regimens. 

I think that the goal for every patient in CLL is very variable and different and should be patient-specific. So the goal for treatment is mainly at the moment, with our therapies that are all not curative, is the quality of life for patients. And so I don’t think that MRD should be our goal for all patients. Again, I think it’s patient-specific and disease-specific and treatment-specific as to what the goal should be.