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What Is Minimal Residual Disease (MRD) in Leukemia? 

Updated on October 09, 2020
Medically reviewed by
Todd Gersten, M.D.
Article written by
Kelly Crumrin

KEY TAKEAWAYS:
  • Minimum residual disease (MRD) is a measurement of how many leukemia cells remain in the body after treatment.
  • MRD is much more precise and accurate than other tests.
  • MRD guides doctors in choosing which leukemia treatment will be most effective.
  • After remission, MRD helps predict how likely a relapse of leukemia is.
  • Monitoring MRD helps doctors know earlier when a relapse may be coming and start treatment sooner.

Every person who is diagnosed with leukemia hopes to achieve lasting remission and avoid relapses. With modern treatments, rates of remission are high for most types of leukemia.1 However, relapse continues to be a serious concern for many people who achieve remission from leukemia. Even just a few cancer cells remaining after treatment could grow and eventually cause relapse.

In recent years, new techniques have emerged to accurately detect and measure even tiny numbers of cancer cells that may be missed by other types of tests.2,3 This measurement of remaining cancer cells is known as minimal residual disease (MRD).2,3 Some tests for MRD can detect even one leukemia cell among 1 million normal cells.2,3

Today, MRD is accepted by the medical community as the strongest factor in predicting outcomes in acute forms of leukemia – acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML).2,4,5,6 MRD is also becoming an important factor in determining the effectiveness of treatment and predicting outcomes in chronic forms of leukemia – chronic myeloid leukemia (CML) and chronic lymphocytic leukemia (CLL).7,8

What Does MRD Tell Your Doctor?
Measuring minimal residual disease provides doctors with vital knowledge in treating leukemia. Testing for MRD is a type of personalized medicine because it enables your doctor to tailor your treatment plan.2 MRD is tested via samples of blood or bone marrow.

MRD measures your response to treatment, telling your doctor how well the initial treatment for leukemia is working.3,4,6 If a standard treatment regimen is not working well enough, your doctor may recommend making changes to treatment that will be more effective in obtaining remission.3,4,6

Monitoring MRD can help your doctor predict in advance when a relapse may be about to happen and start treatment sooner to keep you in remission.3,4,6 MRD measurement can also help your doctor predict what treatment for relapse might benefit you most, for instance, whether a stem cell transplant is warranted.4

Increasingly, MRD is being used during clinical trials as a better standard against which to test the effectiveness of new treatments for leukemia.4 MRD also provides results more quickly, eliminating the need to wait for months after treatment and see whether relapse occurs.2

Measuring MRD can help doctors better predict the long-term survival of many people being treated for leukemia.2

How Does MRD Testing Help You?
Measuring MRD is an important way for your doctor to make certain you are getting the most effective treatment to ensure a lasting remission from leukemia.3 Monitoring for MRD can also help predict a relapse and begin treating it earlier.3 Testing for MRD gives your doctor the information they need to personalize your leukemia treatment and provide the best care possible.2 Together, you and your doctor can make informed decisions about your leukemia treatment plan using the knowledge gained from MRD monitoring.

If you would like to learn more about the role of minimal residual disease in leukemia, visit these external resources:

Learn how MRD is monitored by reading How Is Minimal Residual Disease (MRD) Monitored in Leukemia?

References
  1. Leukemia Outlook / Prognosis. (n.d.). Retrieved from https://my.clevelandclinic.org/health/diseases/4365-leukemia/outlook--prognosis.
  2. Research. (n.d.). Testing for Measurable/Minimal Residual Disease (MRD). Retrieved from https://www.oncolink.org/cancer-treatment/procedures-diagnostic-tests/blood-tests-tumor-diagnostic-tests/testing-for-measurable-minimal-residual-disease-mrd. Accessed September 2019.
  3. Minimal Residual Disease (MRD). (n.d.). Minimal Residual Disease (MRD). Leukemia & Lymphoma Society. https://www.lls.org/sites/default/files/National/USA/Pdf/Publications/FS35_MRD_Final_2019.pdf. Accessed September 2019.
  4. Brüggemann, M., & Kotrova, M. (2017). Minimal residual disease in adult ALL: technical aspects and implications for correct clinical interpretation. Hematology, 2017(1), 13–21. doi: 10.1182/asheducation-2017.1.13
  5. MRD Emerging as a Biomarker in Acute Leukemia. (n.d.). Retrieved from https://www.targetedonc.com/publications/targeted-therapy-news/2018/May-2018/mrd-emerging-as-a-biomarker-in-acute-leukemia.
  6. Ravandi, F., Walter, R. B., & Freeman, S. D. (2018). Evaluating measurable residual disease in acute myeloid leukemia. Blood Advances, 2(11), 1356–1366. doi: 2018016378
  7. Soverini, S., Bassan, R., & Lion, T. (2019). Treatment and monitoring of Philadelphia chromosome-positive leukemia patients: recent advances and remaining challenges. Journal of Hematology & Oncology, 12(1). doi: 10.1186/s13045-019-0729-2
  8. Thompson, M., Brander, D., Nabhan, C., & Mato, A. (2018). Minimal Residual Disease in Chronic Lymphocytic Leukemia in the Era of Novel Agents. JAMA Oncology, 4(3), 394. doi: 10.1001/jamaoncol.2017.2009
Todd Gersten, M.D. is a hematologist-oncologist at the Florida Cancer Specialists & Research Institute in Wellington, Florida. Review provided by VeriMed Healthcare Network. Learn more about him here.
Kelly Crumrin is a senior editor at MyHealthTeams and leads the creation of content that educates and empowers people with chronic illnesses. Learn more about her here.

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