EHA 2019 | The role of MRD in CLL

Peter Hillmen

MRD provides physicians with the tools to determine patient prognosis to a higher degree of accuracy than ever before. Peter Hillmen, MBChB, FRCP, FRCPath, PhD, of the University of Leeds, Leeds, UK, discusses this and the use of MRD for patients with chronic lymphcytic leukemia (CLL) at the 24th Congress of the European Hematology Association (EHA) 2019, held in Amsterdam, Netherlands.

Transcript (edited for clarity):

The role that MRD in CLL, I think, is increasing as we move towards defined duration therapy with targeted treatments, we need to be looking at eradicating disease. So we get durable remissions when we stop the treatment.

So we’ve known for for many years, in fact for over a decade, that if a patient with chemoimmunotherapy or antibody type treatments achieves an MRD-negative remission, their outcome is much better than those patients who don’t have eradication of their disease.

So we’re now getting data, particularly with the venetoclax-based combinations that we are seeing high proportions of patients achieving MRD-negative remissions with non-chemotherapy approaches, both in front line and in relapse. And it’s clear, I think from the data we have so far, and it is maturing rapidly, that the MRD-negative patients in that chemotherapy-free context are doing a lot better.

So I think that what we’ll look at in the trials, MRD is a useful objective measure to see about response, and to show that one type is better than another. And then the real world I think we’re probably looking at using MRD in the future to tailor therapy so we know which patients we can stop, when we should stop the treatment, and potentially whether we should add therapies together to get more patients into MRD-negative remissions.

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