The Fellow on Call: The Heme/Onc Podcast Episode 098: Understanding MRD Testing in CLL
Apr 3, 2024
Delve into the fascinating world of minimal residual disease (MRD) testing in chronic lymphocytic leukemia (CLL). Discover how MRD plays a pivotal role in treatment decisions, the advanced techniques for detection, and the implications of MRD status on patient outcomes. Tune in for insights about the efficacy of methods like flow cytometry and the Clonosec assay, and learn about ongoing research that might reshape treatment strategies. Plus, enjoy a mix of medical insights and entertaining commentary that keeps the conversation lively!
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Definition and Role of MRD in CLL
- MRD stands for Measurable Residual Disease, detecting tiny populations of residual cancer cells after treatment.
- MRD negativity by flow cytometry correlates with deeper remission but its clinical utility in CLL is still under investigation.
Techniques for MRD Detection
- Flow cytometry detects residual CLL cells at a sensitivity of 1 in 10,000 to 1 in 100,000, known as MRD4 or MRD5.
- Molecular techniques like Clonoseq offer even higher sensitivity but lack standardization and clinical integration.
Peripheral Blood vs Bone Marrow MRD
- Peripheral blood MRD testing correlates about 85% with bone marrow testing but the bone marrow remains slightly more sensitive.
- Concordance varies by treatment type, with obinutuzumab showing better peripheral-bone marrow alignment.