Dr. Arora Discusses the Role of MRD Status in CLL

Shagun Arora, MD, assistant clinical professor at the University of California, San Francisco (UCSF) Helen Diller Family Comprehensive Cancer Center, discusses the role of minimal residual disease (MRD) status in the treatment of patients with chronic lymphocytic leukemia (CLL).

A hot topic in the CLL space is using MRD-negative status as a marker to discontinue treatment, says Arora. It is not clear what should be used to measure MRD though, but most clinical trials use 4 color flow cytometry. In the MURANO trial, recently published data showed a MRD-negativity rate of 53% (103/194) following 9 months of treatment with venetoclax (Venclexta) plus rituximab (Rituxan) compared with 12% (23/195) in the bendamustine plus rituximab arm.

The CLARITY and CAPTIVATE trials of ibrutinib (Imbruvica) plus venetoclax are stopping treatment based on MRD status. In CAPTIVATE, if the patients are MRD-negative after 12 cycles, they are being randomized to placebo versus single-agent ibrutinib. In CLARITY, treatment will be completely stopped once MRD negativity is reached.