While minimal residual disease (MRD) monitoring is not yet a standard practice in lymphoma treatment outside of clinical trials, its role in guiding therapeutic strategies is rapidly evolving, according to Reid Merryman, MD, clinical investigator and assistant professor at Dana-Farber Cancer Institute. The integration of MRD assessment in clinical trials is providing valuable insights into how treatment can be tailored based on individual patient responses.
MRD's Evolving Role in Clinical Trials
Dr. Merryman notes that almost all lymphoma trials now incorporate the collection of plasma samples to monitor MRD changes during treatment. These trials are exploring several ways in which MRD can be used to guide therapies. One approach involves assessing MRD changes at an early time point to determine whether to de-escalate or escalate therapy based on the MRD status. Another strategy uses MRD results to guide consolidation therapy, where treatment decisions are made based on MRD status at the end of the initial treatment phase. For example, in mantle cell lymphoma trials, MRD results at the end of treatment may dictate whether additional treatment is necessary.
Tailoring Treatment Based on MRD Status
Furthermore, some trials are investigating the use of serial MRD monitoring to determine when treatment can be stopped or when it should be restarted if MRD emerges. These trials aim to personalize treatment approaches based on the dynamic changes in MRD levels, potentially leading to more effective and less toxic treatment regimens.
The Need for Prospective Trials
Despite the growing interest in MRD monitoring, Dr. Merryman emphasizes the need for prospective, randomized, phase 3 trials to determine the best way to use MRD to guide treatment decisions. Outside of clinical trials, MRD testing is not routinely performed for lymphoma patients, underscoring the importance of establishing evidence-based guidelines for its use in clinical practice.
