Measurable residual disease monitoring in acute myeloid leukaemia: Techniques, timing and therapeutic implications.

Abstract

The detection of measurable residual disease (MRD) in acute myeloid leukaemia (AML) has emerged as one of the strongest prognostic indications of adverse outcomes across different treatment settings and disease stages, independent of baseline genetic risk classification. Multiple techniques for MRD-assessment have been developed and clinically validated, including multiparameter flow cytometry (MFC) and molecular assays such as quantitative PCR (qPCR) and next-generation sequencing (NGS). These approaches have been incorporated into routine clinical practice to evaluate treatment efficacy and refine disease risk stratification. Beyond the prognostic significance, MRD monitoring offers a powerful tool for monitoring subclinical disease, enabling early relapse detection and influencing therapeutic decisions, including consolidation strategies, transplant conditioning, and pre-emptive interventions. In non-intensive treatment settings, MRD may help tailor treatment duration and identify patients eligible for therapy cessation. As the therapeutic landscape of AML continues to evolve with novel agents and strategies, the role and clinical applications of MRD are becoming increasingly relevant. This review summarizes current MRD assessment techniques, optimal measurement timepoints, and clinical applications across different therapeutic settings. We also highlight ongoing innovations and future directions that aim to fully integrate MRD into precision management of patients with AML.