Hematologist-oncologist Dr. Anand Patel explains why repeat testing is critical throughout AML care — from measuring the depth of remission with MRD testing to identifying new mutations if the disease returns.
Dr. Anand A. Patel is the Medical Director of the Inpatient Leukemia Service at the University of Chicago Medical Center. Learn more about Dr. Patel.
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Transcript
Katherine Banwell:
Well, could you walk us through how test results might change a patient’s treatment options over time?
Dr. Anand Patel:
Yeah. So, in my mind, you can think about what someone’s leukemia is at diagnosis, which we’ve discussed. Really kind of looking at the genetic and the chromosomal makeup to allocate risk, and the treatment decisions that are made based on that, at additional diagnosis. You can then think about testing once someone is in a remission, which is where measurable residual disease comes into play. So, not all remissions are created equal. Depth of remission matters.
So, patients that are MRD-negative, using our most sensitive testing, that gives us more confidence that this is a remission that will hopefully be durable, and ultimately be a cure. On the other hand, those patients who still have low levels of disease, we think about, how do we intensify therapy, or think more strongly about a stem cell transplant?
And then the third major time point at which testing is so critical is in this scenario where either someone’s leukemia never went into a remission in the first place, or it went into a remission and then returns. So, what we call a relapse of disease. And leukemia, unfortunately, is not static. Just because someone had a specific mutation in their leukemia cells when they were first diagnosed does not mean those same mutations are what will be there if the disease persists or if it comes back.
So, repeat molecular and cytogenetic testing at time of progression or relapse is critical. Especially because in the relapsed setting, where the disease has gone away and then come back, we have several therapeutic options that rely upon specific mutations being present.