Discussing the Role of MRD in CLL With Talal Hilal, MD
May 16, 2024
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Dr. Talal Hilal from Mayo Clinic discusses measuring MRD in CLL with Chadi Nabhan. They explore MRD detection methods, its role in treatment decisions, challenges with doublet therapies, and the controversy around MRD in CLL.
Undetectable MRD levels in CLL may indicate a deeper remission and potentially better outcomes.
Clinical trials using MRD-guided treatment decisions in CLL have shown improved survival rates.
Deep dives
Understanding Measurable Residual Disease in CLL
Measurable Residual Disease (MRD) in Chronic Lymphocytic Leukemia (CLL) refers to cancer cells that were previously undetectable but can now be seen using advanced techniques like flow cytometry and next-generation sequencing. Achieving undetectable MRD levels may indicate a deeper remission, potentially leading to better outcomes. While the importance of MRD in CLL treatment is debated due to the indolent nature of the disease, eradicating even the last cancer cell could theoretically result in a cure.
MRD-Guided Treatment Decisions in CLL Trials
Clinical trials like the UK study focusing on MRD-guided treatment decisions in CLL have shown promising results with improved progression-free survival and overall survival. The study utilized targeted agent combinations to achieve undetectable MRD levels and then extended treatment duration, leading to positive outcomes. Similar trials exploring time-limited therapy combined with MRD monitoring aim to optimize treatment strategies for CLL patients.
Future Directions and Ongoing Studies in MRD and CLL
Ongoing studies in CLL are investigating the best treatment combinations, such as BTK and BCL2 inhibitors, to enhance MRD rates and long-term outcomes. Current trends suggest a shift towards targeted agent doublets and away from continuous BTK inhibitor use due to resistance concerns. Triplet therapies and optimized frontline approaches are being explored to determine the most effective strategies for managing CLL in the future.
Dr. Hilal, of the Mayo Clinic, joins Chadi Nabhan, MD, MBA, FACP, on “The HemOnc Pulse” to discuss measurable residual disease (MRD) and the debates surrounding its use for response assessment in patients with chronic lymphocytic leukemia (CLL).
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