ISAL 2025 | Flow-based MRD versus other MRD detection techniques in AML

So all the other methods are molecular-based, so they’re detecting molecular targets inside the cell, and flow is detecting proteins on the outside of the cell. So it’s detecting the whole cell, it’s a single-cell analysis. I think the first point to say is that when you have, you know, the validated molecular methods, then flow MRD should be used integrated with those rather than preferentially. But actually, most patients don’t have a marker for molecular MRD for the PCR. If you add in the new technology of FLT3 ITD NGS MRD, then that only adds another 6% of patients. So most patients need to be covered by flow. Even if you have a molecular marker, we see more and more with molecularly targeted therapies that you can get wild-type relapses, which means that you’ve lost the target with which you’re monitoring MRD. And therefore, flow provides a parallel orthogonal assay, which enables us to sort of pick up those relapses before it’s too late. And then the other thing about flow is that it can detect MRD specifically in immature cells. While with the molecular technologies, you don’t know whether what you’re detecting is actually within the immature cells or in the mature cells. And that makes a difference, particularly for differentiating therapies where you may still have molecular MRD targets detected, but most of that actually may be in the mature cell population and that won’t actually be causing relapse in the future.

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