Monitoring of minimal residual disease in acute myeloid leukemia.

PURPOSE OF REVIEW

In acute myeloid leukemia, minimal residual disease (MRD) detection is recognized as a critical diagnostic tool to assess the quality of response after induction therapy and to outline postremissional programs based on the individual risk of relapse. The most popular methods to investigate MRD are multiparametric flow cytometry (MPFC) and polymerase chain reaction, since these techniques have proven sensitive and specific enough to allow MRD to be studied serially. In the present review we will focus on the use of MPFC for monitoring of MRD, addressing the main technical and clinical issues.

RECENT FINDINGS

Lack of standardization among different laboratories, immunophenotypic stability, identifications of thresholds and time-points during follow-up represent the major subjects of confrontation whose definitive solution might rely on the application of new technologies and dedicated statistical approaches.

SUMMARY

Studies of MRD should provide us the opportunity to generate comprehensive prognostic algorithms which take into account conventional parameters, such as cytogenetic and genetic profile, and those strictly inherent to the quality of response, such as determination of residual leukemia. This will greatly enhance development of personalized therapeutic approaches, avoiding the situation of under or over drug exposure.