2025 update on MRD in acute myeloid leukemia: a consensus document from the ELN-DAVID MRD Working Party.
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Cloos Jacqueline, Valk Peter J M, Thiede Christian, Döhner Konstanze, Roboz Gail J, Wood Brent L, Walter Roland B, Wang Sa, Wierzbowska Agnieszka, Wei Andrew H, Wu David, Vergez François, Venditti Adriano, van der Reijden Bert A, van de Loosdrecht Arjan A, Tiong Ing Soo, Thol Felicitas R, Subklewe Marion, Roumier Christophe, Reuvekamp Tom, Ravandi Farhad, Preudhomme Claude, Plesa Adriana, Othman Jad, Ossenkoppele Gert J, Ofran Yishai, Mimoun Aguirre, Maurillo Luca, Majchrzak Agata, de Leeuw David, Kern Wolfgang, Kim Dennis Dong Hwan, Ikoma-Colturato Maura R V, Haaksma Lukas H, Guzman Monica L, Feuring Michaela, Depreter Barbara, Czyz Anna, Bücklein Veit, Baer Constance, Bachas Costa, Freeman Sylvie D, Buccisano Francesco, Hourigan Christopher S, Dillon Richard, Heuser Michael
Аннотация
Measurable residual disease (MRD) monitoring has become a critical component in the management of acute myeloid leukemia (AML), to inform prognosis, guide therapy, and serve as a key end point in clinical trials. The 2025 update of the MRD guideline provides a comprehensive and refined framework for MRD assessment, aligned with the European LeukemiaNet (ELN) 2022 genetic risk classification. Developed by members of the ELN AML MRD Working Party, the guidelines incorporate expert consensus determined through a 2-stage Delphi round. They address the clinical implementation of MRD methodologies, technical considerations, integration into clinical trials, and future directions. Importantly, MRD recommendations are tailored to individual prognostic and genetic subgroups. A new qualitative MRD response category, designated as optimal, warning, or high risk of treatment failure, has been introduced to facilitate contextual interpretation of the MRD burden and its clinical relevance. Notably, ultrahigh-sensitivity next-generation sequencing-based MRD assessment is now recommended for FLT3 internal tandem duplication-mutated AML after intensive chemotherapy and before allogeneic hematopoietic cell transplantation. A total of 56 recommendations were formulated, with 53 achieving a high level of consensus (≥90%). These updated guidelines represent a major step forward toward harmonizing MRD assessments in AML and enhancing its clinical utility across diverse treatment settings.