CLL Management: Towards an MRD Guided Therapy

The field of immunophenotypic and molecular diagnostics has experienced significant transformation, particularly over the past two decades, becoming a pivotal component in diagnosing and even treating various diseases.Minimal residual disease (MRD) assessment has gained substantial clinical significance in hematologic malignancies, serving as an indicator of treatment response and playing a critical role in risk stratification and management decisions conditions.In chronic lymphocytic leukemia (CLL), MRD assessment has evolved over the years, now being an integral part of evaluating treatment responses and an efficient tool for detecting disease progression.MRD status has important prognostic implications post-treatment and can influence decisions regarding treatment options, duration, and intensity.CLL patients who achieve undetectable MRD after treatment tend to have better outcomes compared to those with detectable MRD following specific treatment regimens.The shift in CLL treatment strategies from chemotherapy and chemo-immunotherapy to targeted therapies has altered the clinical significance of MRD, which varies depending on the treatment or combination of treatments used.MRD measurement generally relies on highly sensitive techniques that assess the immunophenotypic profiles of tumor cells and specific genetic alterations, such as flow cytometry, polymerase chain reaction (PCR), and genetic sequencing.Currently, multicolor flow cytometry, which detects CLL cells in peripheral blood, is the most widely used method for MRD detection.However, clinical trial data on the optimal assay for determining undetectable MRD in CLL remains limited.This review aims to provide an overview of the current techniques for MRD measurement in CLL and discuss its clinical significance in guiding personalized treatment for patients.