Minimal residual disease in hematopoietic malignancy: Technical approaches and clinical significance

Abstract New technology continues to provide methods to refine the definition of complete remission in patients with hematopoietic malignancy. Recent evidence indicates that quantitation of residual tumor burden over time may identify gradual increases indicative of potential relapse. It is the general hope that this increased sensitivity for identification of patients with residual tumor burden will allow for a more effective selection of therapeutic alternatives for these patients. In order to accurately assess whether lowering the threshold for definition of remission improves the clinical outcome of patients with MRD, future studies must include several important parameters. Effective clinical studies will require large groups of patients meeting carefully designed diagnostic criteria with strictly controlled, homogenous treatment protocols. In addition, they must utilize a multidisciplinary technical approach for the detection of MRD in order to properly assess the ability of each technology to measure clinically significant parameters. The choice of the most effective technologies and when to test the patient will be identified only through these carefully planned clinical trials. Additional considerations of cost and availability must then enter into utilization decisions as important financial considerations to be weighed against clinical significance.