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ASH 2021 | Usefulness of MRD in treatment of CLL

Arnon Kater, MD, PhD, University of Amsterdam, Amsterdam, Netherlands, discusses how to work with minimal residual disease (MRD) when treating patients with chronic lymphocytic leukemia (CLL). Prof. Kater suggests that the predictive value of MRD may be different depending on what treatment the patient receives, and also discusses how much clinicians should rely on MRD to inform treatment decisions. This interview took place at the 63rd ASH Annual Meeting and Exposition congress in Atlanta, GA.

Transcript (edited for clarity)

So the question is a bit how you work now with MRD and so far, I think the data is pretty convincing that MRD is a very robust surrogate marker for progression-free survival, very early marker post-chemoimmunotherapy that we knew for a long time already, but also for venetoclax plus an antibody. Whether it’s also a very robust predictive marker for venetoclax ibrutinib, it’s still too early to call both from the CAPTIVATE study and from the GLOW study that will be presented tomorrow...

So the question is a bit how you work now with MRD and so far, I think the data is pretty convincing that MRD is a very robust surrogate marker for progression-free survival, very early marker post-chemoimmunotherapy that we knew for a long time already, but also for venetoclax plus an antibody. Whether it’s also a very robust predictive marker for venetoclax ibrutinib, it’s still too early to call both from the CAPTIVATE study and from the GLOW study that will be presented tomorrow. We know that people do get into an MRD negative state, but we also see that patients with an MRD positive disease also as I just discussed, remain very stable over time. So it might very well be that the predictive value of MRD is different depending on the treatment you give. Second thing is that we haven’t, maybe in the HOVON-141 we just discussed, but it’s all in trials, we haven’t really tested yet whether or not a patient should be treated according to their MRD. Can you stop treatment very early if you’re MRD negative? That’s one question, the second question is can you treat or retreat patients as soon as they get MRD positive again, or should you just wait for clinical symptoms because CLL can be a disease where you have circulating tumor cells without any complaints? And that’s not known yet and to my personal opinion, but it’s a personal opinion, if we don’t have that data yet, I think measuring it in an outside trial setting is still a bit doubtful whether it really benefits your patients.

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