Dr. Sharman on ​the Challenges of Adjust​ing Treatment Based on MRD Status in CLL

Jeff P. Sharman, MD, director of research at Willamette Valley Cancer Institute and medical director of hematology research for The US Oncology Network, discusses the challenges of adjusting treatments based on minimal residual disease (MRD) status in high-risk chronic lymphocytic leukemia ​(CLL).

MRD status is not ready for primetime use in guiding treatment decisions, says Sharman. Moreover, the field does not have robust evidence to suggest that MRD-driven treatment decisions leads to differential outcomes in this patient population.

However, it’s widely understood that patients treated with single-agent BTK inhibitors rarely achieve MRD negativity, Sharman adds. 

Several other treatment​s, such as anti-CD20 antibodies and BCL-2 inhibitors, can elicit MRD negativity,​ says Sharman. Amongst patients treated with BCL-2 inhibitors, it’s now understood that the failure to achieve MRD negativity could correlate with shorter progression-free survival. Additionally, it remains unclear whether continuing BCL-2 inhibitors are beneficial still remain uncertain, Sharman concludes.