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Καταχωρήθηκε: Τρίτη 23 Οκτ 2018
1. The optimal time for MRD testing may depend on the type of MRD. CBFB-MYH11 AML displayed a slower clone regrowth than AML with the other molecular signatures and recommended MRD testing for CBFB-MYH11 be performed every 6 months, whereas testing for PML-RARA MRD was recommended for every 2 months.
 
2. Another subject of debate is whether routine clinical sampling for MRD testing should be performed on peripheral blood or bone marrow. The ELN MRD consensus report recommends testing both bone marrow and blood for molecular MRD during treatment.
 
3. The choice of an MRD target can be confounded by the persistence of genetic abnormalities in patients in long-term remission.For example, mutated DNMT3Awith up to 50% VAF can persist in patients who have been in remission for several years.
 
4. More studies are also needed to determine relevant MRD thresholds, which will of necessity vary according to the technology used for assessment and the type of tissue under study
 
5. Viable targets for molecular MRD monitoring include leukemic fusion genessuch as promyelocytic leukemia gene retinoic acid receptor-α (PML-RARA), core-binding factor subunit β myosin heavy chain 11 (CBFB-MYH11), and runt-related transcription factor 1 (RUNX1)/RUNX1 translocated to 1 (RUNX1T1), and mutant NPM1.24 Wilms’ tumor gene (WT1) should not be used as an MRD marker because of poor sensitivity and specificity unless no other MRD markers are available.24 The ELN MRD Working Party recommends against use of Fms-like tyrosine kinase internal tandem duplication (FLT3-ITD), FLT3-TKD, NRASKRASIDH1IDH2MLL-PTD, and expression levels of EVI1 as single markers of MRD because they are prone to frequent losses or gain
 
6. A recent study showed that NGS can be used for MRD FLT3-ITD
 
FAZIT
Molecular MRD assessment should be conducted in bone marrow and peripheral blood every 3 months for 24 months after the end of treatment, or in peripheral blood every 4 to 6 weeks. MRD testing should be performed before and after bone marrow transplant.
 
Ref. Schuurhuis GJ, et alMinimal/measurable residual disease in AML: a consensus document from the European LeukemiaNet MRD Working PartyBlood.2018;131(12):1275-1291.
 
Presenter: Prof. Spyridonidis
Patricipants: Dr Liga, Dr Spyridis, Dr Lekka, Dr Bountouris
 

 

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