The essentials-measurable residual disease in hematopoietic neoplasms: current testing landscape and future directions.

Abstract

Measurable residual disease (MRD) analysis, also known as minimal residual disease analysis, has become an essential component of routine clinical management in many hematopoietic neoplasms. Measurable residual disease status in the absence of morphologic disease holds prognostic value and can acutely affect treatment decisions. Measurable residual disease monitoring is described in acute leukemia, multiple myeloma, and chronic lymphocytic leukemia. We discuss the approach to MRD assessment of these hematologic neoplasms using flow cytometry and molecular techniques. The appropriate use of available ancillary techniques is crucial to assess patients for MRD. Interpreting these results in the appropriate clinical context is challenging and often requires expertise. Incorporating the results into disease management is critical for improved outcomes. Consensus guidelines on MRD assessment in hematopoietic neoplasms continue to evolve. Further, emerging technologies and laboratory availability are important practical considerations for pathologists who are implementing MRD analysis. From this review, pathologists can gain an anecdotal perspective on the application and interpretation of advanced studies to assess the MRD status of patients with hematopoietic malignancies.