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SOHO 2020 | Value of MRD measurement in CLL

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Michael Hallek

Michael Hallek, MD, University Hospital of Cologne, Cologne, Germany, discusses the significance of minimal residual disease (MRD) in the treatment and management of chronic lymphocytic leukemia (CLL), as well its value as a surrogate marker in clinical trials. Furthermore, Dr Hallek outlines the use of MRD in clinical practice as a tool to determine treatment endpoints and highlights the CLARITY study combining ibrutinib with venetoclax to eradicate detectable CLL with the intention of stopping therapy. This interview was recorded via an online conference call with The Video Journal of Hematological Oncology (VJHemOnc).

Transcript (edited for clarity)

In my opinion, it has increasing value also in the practice. We start to use it as a surrogate parameter in clinical trials and this is where it has gotten a lot of attention and importance, but in practice it often allows me, in my personal practice, to decide whether I can stop therapy. There is a very intelligent trial by our British colleagues called the CLARITY concept, where they study a short duration of treatment, which is twice the time to get to the point of MRD negativity...

In my opinion, it has increasing value also in the practice. We start to use it as a surrogate parameter in clinical trials and this is where it has gotten a lot of attention and importance, but in practice it often allows me, in my personal practice, to decide whether I can stop therapy. There is a very intelligent trial by our British colleagues called the CLARITY concept, where they study a short duration of treatment, which is twice the time to get to the point of MRD negativity. So this approach is one of the things where we measure MRD and then decide, “Well, at this point or sometime later, we may stop therapy.”

In my personal practice, especially in high-risk patients, so the relapses or the TP53 mutated, I very often use this as an endpoint and then we discuss with the patient, “Shall we stop now?” and we often stop therapy at this point. “Or shall we continue?” So my personal bias and opinion is that it is gaining importance because it’s even more reliable than imaging. It is also much easier to perform because you can’t do imaging with CAT scans every, let’s say, three months. It’s costly and above all has also side effects, which is radiation, and so we prefer to use MRD assessment.

I should also add, to give an unbiased view on this topic, that MRD, so far, is not really acknowledged by the health insurances or the agencies all over the world. So, if I give this recommendation I’m fully aware that this is about to become a very important routine marker but as of today neither the guidelines nor the official regulatory agencies have acknowledged MRD as a clinical endpoint. So, it’s in the coming or it’s moving up to routine practice, in my opinion.

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