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SOHO 2026 | Can current MRD assays accurately predict relapse in AML? Limitations and future directions
Farhad Ravandi, MD, The University of Texas MD Anderson Cancer Center, Houston, TX, discusses the need for improved measurable residual disease (MRD) testing in acute myeloid leukemia (AML). Dr Ravandi explains that some patients who are MRD- negative still relapse, partly due to the loss of target mutations such as FLT3 during treatment, highlighting the limitations of single-mutation MRD assessment. He emphasizes the need for deeper, more sensitive approaches with broader mutation coverage. This interview took place at the 14th Annual Meeting of the Society of Hematologic Oncology (SOHO 2026) in Houston, TX.
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Transcript
This is actually a very good question because it just shows us that the currently available MRD assays are imperfect in AML, particularly. You can see this from all the publications when you have patients who are MRD negative and relapsing. This is not just in what you just mentioned, but in any MRD study, and if you look at any MRD survival curve, patients who are MRD negative, still a proportion of them relapse...
This is actually a very good question because it just shows us that the currently available MRD assays are imperfect in AML, particularly. You can see this from all the publications when you have patients who are MRD negative and relapsing. This is not just in what you just mentioned, but in any MRD study, and if you look at any MRD survival curve, patients who are MRD negative, still a proportion of them relapse. That just means your assay was not sensitive enough to detect every leukemia cell. And also, as mentioned, it is possible that you lose your target mutation as a part of therapy. So in FLT3-mutated AML, it is actually now very much common to lose FLT3 mutation at the time of relapse. So I think eventually an ideal MRD assay would be not only deep and sensitive, but also would have a breadth of mutations, as in the original leukemic cells’ complete molecular characteristics. Now, that would be the ideal MRD assay if it could go actually very deep as well. That may be coming in the future using whole genome assays. And again, with that, the depth is important because, you know, if you can detect it only one in a thousand, it’s not going to be adequate. So you need to have a very deep assay that has a breadth of mutations. And that’s something in the future.
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