Reviews
Measurable Residual Disease in Acute Leukaemias: A Narrative Review on Specimen Adequacy, Assay Selection, Interpretive Pitfalls and Challenges for the Practicing Pathologist
EE01-EE08
Correspondence
Dr. Sneha Sukumar,
Junior Resident, Department of Pathology, Datta Meghe Institute of Medical Sciences, Sawangi (Meghe), Wardha-442004, Maharashtra, India.
E-mail: drsnehasukumar1996@gmail.com
Measurable Residual Disease (MRD) is a key prognostic marker in acute leukaemias, guiding therapy and risk stratification. Even in morphologic remission, residual clones drive relapse, highlighting the need for sensitive, standardised detection. This narrative review synthesises evidence from PubMed, Embase, and Scopus (2000–2025) together with international guidelines from the European LeukaemiaNet (ELN), the National Comprehensive Cancer Network (NCCN), the World Health Organisation (WHO), and the EuroFlow Consortium (EuroFlow). Multiparameter Flow Cytometry (MFC) remains the frontline tool for its accessibility and speed, though challenged by haematogone overlap, immunophenotypic shifts, and CD19-negative relapse. Molecular assays {Quantitative Reverse Transcription Polymerase Chain Reaction (RT-qPCR), Next-Generation Sequencing (NGS)} provide higher sensitivity but require caution in clonal haematopoiesis; DNMT3A, TET2, and ASXL1 mutations are excluded from Acute Myeloid Leukaemia (AML) Minimal Residual Disease (MRD) reporting. Standardised Breakpoint Cluster Region (BCR)::ABL Proto-Oncogene 1, Non-Receptor Tyrosine Kinase (ABL1) monitoring exemplifies harmonised molecular metrics, though broader consensus is needed. Comparative insights across B-precursor Acute Lymphoblastic Leukaemia (B-ALL), T-cell Acute Lymphoblastic Leukaemia (T-ALL) , AML, and related neoplasms reveal disease-specific thresholds. Emerging technologies, namely, digital PCR, error-corrected NGS, single-cell profiling, promise unprecedented resolution, positioning MRD as a cornerstone of precision therapy.