Clinical Use of Measurable Residual Disease in Adult All: Recommendations From a Panel of Us Experts

Authors

Nicholas J Short
Ibrahim Aldoss
Daniel J DeAngelo
Marina Konopleva
Jessica Leonard
Aaron C Logan
Jae Park
Bijal Shah
Wendy Stock
Elias Jabbour

Publication Date

3-25-2025

Journal

Blood Advances

Abstract

Measurable residual disease (MRD) is a powerful predictor of clinical outcomes in acute lymphoblastic leukemia (ALL). In addition to its clear prognostic importance, MRD information is increasingly used in clinical decision algorithms to guide therapeutic interventions. Although it is well established that achievement of MRD-negative remission is an important end point of ALL therapy, the prognostic and therapeutic implications of MRD in an individual patient are influenced by both disease-related factors (eg, cytomolecular risk) and assay-related factors (eg, sensitivity, specimen source, and timing of assessment), which add complexity to MRD-guided treatment decisions. In this review, we discuss the data supporting the use of MRD assessment in adult ALL and how this information can rationally inform clinical decisions, including selection of patients for MRD-directed therapies or allogeneic hematopoietic stem cell transplantation. We also discuss important interpretative challenges related to novel high sensitivity next-generation sequencing-based MRD assays, which are becoming increasingly used in clinical practice.

Keywords

Humans, Neoplasm, Residual, Precursor Cell Lymphoblastic Leukemia-Lymphoma, Adult, Prognosis, Hematopoietic Stem Cell Transplantation, Disease Management, High-Throughput Nucleotide Sequencing

DOI

10.1182/bloodadvances.2024015441

PMID

39853316

PMCID

PMC11960638

PubMedCentral® Posted Date

1-28-2025

PubMedCentral® Full Text Version

Post-print

Published Open-Access

yes