Reviews
Measurable Residual Disease in Acute Leukaemias: A Narrative Review on Specimen Adequacy, Assay Selection, Interpretive Pitfalls and Challenges for the Practicing Pathologist
Correspondence Address :
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.
Clonal haematopoiesis, Flow cytometry, Neoplasm, Precision therapy
DOI: 10.7860/JCDR/2026/89852.24428
Date of Submission: Apr 18, 2026
Date of Peer Review: May 12, 2026
Date of Acceptance: Jun 18, 2026
Date of Publishing: Oct 01, 2026
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was informed consent obtained from the subjects involved in the study? No
• For any images presented appropriate consent has been obtained from the subjects. NA
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: May 07, 2026
• Manual Googling: Jun 12, 2026
• iThenticate Software: Jun 15, 2026 (1%)
ETYMOLOGY: Author Origin
EMENDATIONS: 7
- Emerging Sources Citation Index (Web of Science, thomsonreuters)
- Index Copernicus ICV 2017: 134.54
- Academic Search Complete Database
- Directory of Open Access Journals (DOAJ)
- Embase
- EBSCOhost
- Google Scholar
- HINARI Access to Research in Health Programme
- Indian Science Abstracts (ISA)
- Journal seek Database
- Popline (reproductive health literature)
- www.omnimedicalsearch.com
