Leukemia specialists: How advances in measurable residual disease (MRD) are improving cancer care
September 17, 2025
Medically Reviewed | Last reviewed by and on September 08, 2025
Measurable residual disease (MRD) is a monitoring tool that physicians use to assess the remission status of patients with leukemias, lymphomas, myelomas and other blood disorders.
Formerly known as ¡°minimal residual disease,¡± this term describes a situation in which cancer cells are still present in the body after treatment, yet undetectable using current testing methods.
Two of our leukemia specialists, , and , explored this subject in a recent . Here are three highlights from that discussion.
Next-generation sequencing can now reveal ¡®a needle in a haystack¡¯
Patients with blood cancers used to be monitored for relapse using:
- Flow cytometry, which reveals disease through certain patterns of refracted laser light, and
- Polymerase chain reaction (PCR) tests, which are highly sensitive molecular tests that detect specific genetic material from cancer cells
But sometimes, patients would seem to be cured based on these tests, only to relapse some months later. That got doctors to questioning why. Here¡¯s the conclusion ours came to: even if some patients appeared to have no residual disease, it was only because we weren¡¯t able to detect it yet.
One possible solution? Next-generation sequencing.
¡°With next-generation sequencing, we can pick out a single leukemia cell from a sea of a million normal ones,¡± explains Haddad. ¡°This is a very, very minimal level of disease that would¡¯ve previously gone unnoticed ¡ª like a needle in a haystack. This new test can help us detect any little seed left behind so we can completely eradicate the cancer. This marks a real paradigm shift.¡±
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Tracking leukemia with minimal residual disease
How next-generation sequencing is changing the way we treat patients
Chronic lymphocytic leukemia was once considered ¡°incurable¡± because there was always some undetectable level of disease in the body. But with next-generation sequencing, that may be changing.
¡°Before, we might¡¯ve had to wait until a patient had overt progression or was in full-blown relapse before we could treat them,¡± Pemmaraju explains. ¡°Now, we can preemptively change their therapies in order to stop it before it ever gets to that point. This is a practice-changing development.¡±
¡°If you truly have no leukemia left after finishing treatment, this may also allow that you remain under close observation for a long time,¡± adds Haddad.
What the future holds for MRD
Haddad and Pemmaraju are both eager to see how MRD technology unfolds.
¡°Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare hybrid disease that involves the skin, bone marrow, lymph nodes and even the central nervous system,¡± explains Pemmaraju. ¡°So, it¡¯s pretty unusual, even when compared to other leukemias. But what if we could create an MRD assay for each organ system? Could there be a skin MRD? A central nervous system MRD? And, could we standardize those so that they were the same around the world?¡±
¡°Over the next 5 to 10 years, I think artificial intelligence (AI) will be taking over the field,¡± adds Haddad. ¡°Some diseases are so heterogenous that not even any two specialists may agree on what they actually are. But AI could analyze 10,000 or even 100,000 case studies and come up with a model to determine if disease is still present.¡±
To hear the entire exchange between Haddad and Pemmaraju, .
or call 1-877-632-6789.