Elaine Coustan-Smith1, Dario Campana. 1. Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore. paeecs@nus.edu.sg
Abstract
PURPOSE OF REVIEW: In patients with acute myeloid leukemia (AML), measuring response to treatment is essential to guide clinical decisions. Methods for detecting disease beyond the resolution limit of morphology (i.e., minimal residual disease, MRD) are now widely available. We here discuss their merits and the results of side-to-side comparisons. RECENT FINDINGS: The ever-increasing comprehension of the molecular genetics of AML has led to the identification of targets for molecular monitoring of MRD in the majority of AML cases. Likewise, virtually all cases express aberrant immunophenotypes suitable for MRD monitoring by flow cytometry, a progress bolstered by powerful new-generation instruments. The clinical significance of MRD monitoring by either approach has been corroborated by recent results. However, with few exceptions, most of the studies continue to rely on retrospectively determined cut-off levels and time points. Moreover, when applied in parallel, the two approaches have yielded contradictory results. SUMMARY: MRD monitoring can help predicting the risk of relapse better than morphology and also provide endpoints for clinical testing of experimental agents. MRD can be applied to guide therapy but one must carefully consider the characteristics of the methods used and the degree of expertise of the laboratory performing the test.
PURPOSE OF REVIEW: In patients with acute myeloid leukemia (AML), measuring response to treatment is essential to guide clinical decisions. Methods for detecting disease beyond the resolution limit of morphology (i.e., minimal residual disease, MRD) are now widely available. We here discuss their merits and the results of side-to-side comparisons. RECENT FINDINGS: The ever-increasing comprehension of the molecular genetics of AML has led to the identification of targets for molecular monitoring of MRD in the majority of AML cases. Likewise, virtually all cases express aberrant immunophenotypes suitable for MRD monitoring by flow cytometry, a progress bolstered by powerful new-generation instruments. The clinical significance of MRD monitoring by either approach has been corroborated by recent results. However, with few exceptions, most of the studies continue to rely on retrospectively determined cut-off levels and time points. Moreover, when applied in parallel, the two approaches have yielded contradictory results. SUMMARY: MRD monitoring can help predicting the risk of relapse better than morphology and also provide endpoints for clinical testing of experimental agents. MRD can be applied to guide therapy but one must carefully consider the characteristics of the methods used and the degree of expertise of the laboratory performing the test.
Authors: Juan Ouyang; Maitrayee Goswami; Guilin Tang; Jie Peng; Farhad Ravandi; Naval Daver; Mark Routbort; Sergej Konoplev; Pei Lin; L Jeffrey Medeiros; Jeffrey L Jorgensen; Sa A Wang Journal: Am J Hematol Date: 2015-04-02 Impact factor: 10.047
Authors: Seth E Karol; Elaine Coustan-Smith; Xueyuan Cao; Sheila A Shurtleff; Susana C Raimondi; John K Choi; Raul C Ribeiro; Gary V Dahl; William Paul Bowman; Jeffrey W Taub; Barbara Degar; Wing Leung; James R Downing; Ching-Hon Pui; Jeffrey E Rubnitz; Dario Campana; Hiroto Inaba Journal: Br J Haematol Date: 2014-08-28 Impact factor: 6.998
Authors: Juan Ouyang; Maitrayee Goswami; Jie Peng; Zhuang Zuo; Naval Daver; Gautam Borthakur; Guilin Tang; L Jeffrey Medeiros; Jeffrey L Jorgensen; Farhad Ravandi; Sa A Wang Journal: Am J Clin Pathol Date: 2016-06-12 Impact factor: 2.493