What are the Controversies Surrounding MRD in Blood Cancers?
Apr 25, 2024
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Alan Skarbnik, MD, and Manni Mohyuddin, MBBS, discuss measurable residual disease (MRD) in blood cancers, highlighting controversies, implications of MRD negativity, harmonizing MRD thresholds, and testing MRD technology in trials. They explore the challenges in achieving and maintaining MRD negativity for long-term disease control, individualized approaches based on disease specifics, and the importance of overall survival benefits in chronic diseases like CLL.
MRD in blood cancers offers accurate response assessments but lacks clear guidelines for treatment decisions.
Harmonizing MRD testing methods is essential to ensure consistent and reliable results for patient management.
Deep dives
Importance of MRD in Hematologic Malignancies
MRD, or measurable residual disease, is a critical concept in hematology, offering insight into disease detection beyond conventional methods such as imaging studies. The ability to detect minimal amounts of cancer cells directly in the bone marrow has revolutionized response assessments and treatment approaches in diseases like myeloma and CLL. While the technology signifies a significant advancement providing more accurate data, the challenge remains in determining how to act on this information to avoid over or under-treatment until clinical trials establish clear guidelines.
Differences in MRD Testing Thresholds
One of the challenges in MRD evaluation is the lack of consensus on the threshold to determine positivity or negativity. Variability in technologies used, such as flow cytometry versus next-generation sequencing, contributes to differing sensitivity levels, impacting treatment decisions. While efforts are underway to harmonize testing methodologies, regulatory requirements and evolving technologies influence the interpretation of MRD results, sparking the need for standardized approaches to ensure accurate and consistent assessments.
MRD as a Prognostic Marker vs. Surrogate Marker
MRD serves as a powerful prognostic marker, predicting favorable outcomes for patients achieving negativity post-treatment. However, its role as a surrogate marker, reflecting treatment effectiveness in terms of overall survival, remains complex. Studies in myeloma reveal discrepancies between achieving MRD negativity and actual survival benefits, questioning the direct correlation between MRD status and long-term outcomes, highlighting the need for comprehensive assessments beyond prognostic implications.
Considerations for Escalation and De-escalation in Treatment
In the realm of high-risk and aggressive hematologic diseases, the discussion around escalation or de-escalation of treatment based on MRD status is nuanced. While MRD negativity signifies a favorable response in certain patient populations, the decision to escalate therapy for rapid MRD rise in high-risk individuals demands a personalized approach. Balancing the benefits of achieving MRD negativity with the risks of intensifying treatment underscores the ongoing need for individualized strategies guided by evolving research and patient-specific factors.
On this episode of "The HemOnc Pulse," Alan Skarbnik, MD, of Novant Health, and Manni Mohyuddin, MBBS, of the University of Utah, discuss the concept of measurable residual disease (MRD) in hematologic malignancies and highlight the polarized views surrounding MRD.
They also weigh the implications of MRD negativity, how to harmonize the MRD threshold, and how trials are putting MRD technology to the test.
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