2025 update on MRD in acute myeloid leukemia: a consensus document from the ELN-DAVID MRD Working Party
Abstract
Abstract Measurable residual disease (MRD) monitoring has become a critical component in the management of acute myeloid leukemia (AML), to inform prognosis, guide therapy, and serve as a key end point in clinical trials. The 2025 update of the MRD guideline provides a comprehensive and refined framework for MRD assessment, aligned with the European LeukemiaNet (ELN) 2022 genetic risk classification. Developed by members of the ELN AML MRD Working Party, the guidelines incorporate expert consensus determined through a 2-stage Delphi round. They address the clinical implementation of MRD methodologies, technical considerations, integration into clinical trials, and future directions. Importantly, MRD recommendations are tailored to individual prognostic and genetic subgroups. A new qualitative MRD response category, designated as optimal, warning, or high risk of treatment failure, has been introduced to facilitate contextual interpretation of the MRD burden and its clinical relevance. Notably, ultrahigh-sensitivity next-generation sequencing–based MRD assessment is now recommended for FLT3 internal tandem duplication–mutated AML after intensive chemotherapy and before allogeneic hematopoietic cell transplantation. A total of 56 recommendations were formulated, with 53 achieving a high level of consensus (≥90%). These updated guidelines represent a major step forward toward harmonizing MRD assessments in AML and enhancing its clinical utility across diverse treatment settings.
Article Details
Authors (46)
Jacqueline Cloos
1Department of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
Peter J. M. Valk
2Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
Christian Thiede
7University Hospital, Dresden University of Technology, Dresden, Germany
Konstanze Döhner
12University Hospital of Ulm, Ulm, Germany
Gail J. Roboz
Weill Cornell Medicine, New York Presbyterian Hospital, New York
Brent L. Wood
Department of Pathology and Laboratory Medicine, Children’s Hospital of Los Angeles, Los Angeles
Roland B. Walter
Sa Wang
College of Chemistry, Frontiers Science Center for New Organic Matter
Agnieszka Wierzbowska
15Department of Hematology, Medical University of Lodz, Lodz, Poland
Andrew H. Wei
David Wu
Francois Vergez
3Centre de Recherches en Cancérologie de Toulouse, Université de Toulouse, INSERM U1037, Centre National de la Recherche Scientifique U5077, Toulouse, France
Adriano Venditti
23Department of Biomedicine and Prevention, University of Rome tor Vergata, Rome, Italy
Bert A. van der Reijden
24Department of Laboratory Medicine, Laboratory of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
Arjan A. van de Loosdrecht
Ing Soo Tiong
Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
Felicitas R. Thol
26Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
Marion Subklewe
Ludwig Maximilian University Hospital, Munich, Germany
Christophe Roumier
30Laboratory of Hematology and Flow cytometry, CHU Lille, UMR9020 CNRS-UMR-S1277 INSERM, University of Lille, Lille, France
Tom Reuvekamp
1Department of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
Farhad Ravandi
Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
Claude Preudhomme
Unité Mixte de Recherche (UMR) 9020-UMR-S 1277-Canther-Cancer Heterogeneity, Plasticity and Resistance to Therapies, Institut de Recherche contre le Cancer de Lille, University of Lille, CNRS, Inserm, Centre Hospitalier Universitaire Lille, Lille, France
Adriana Plesa
33Laboratory of Hematology and Flow cytometry, Lyon-Sud Hospital, HCL CHU Lyon, CRCL INSERM 1052/CNRS 5286, University of Lyon, Hospices Civils de Lyon, Lyon, France
Jad Othman
3The University of Sydney, Sydney, Australia
Gert J. Ossenkoppele
1Department of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
Yishai Ofran
Aguirre Mimoun
38Laboratoire d'Hématologie, CHU Bordeaux, Bordeaux, France
Luca Maurillo
23Department of Biomedicine and Prevention, University of Rome tor Vergata, Rome, Italy
Agata Majchrzak
39Department of Experimental Hematology, Copernicus Memorial Hospital, Lodz, Poland
David de Leeuw
1Department of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
Wolfgang Kern
40MLL Munich Leukemia Laboratory, Munich, Germany
Dennis Dong Hwan Kim
16Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
Maura R. V. Ikoma-Colturato
43Flow Cytometry Laboratory, Hospital Amaral Carvalho, Jaú São Paulo, Brazil
Lukas H. Haaksma
1Department of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
Monica L. Guzman
7Division of Hematology and Oncology, Department of Medicine, Weill Cornell Medicine, New York, NY
Michaela Feuring
6Department of Internal Medicine III, Ulm University Hospital, Ulm, Germany
Barbara Depreter
44Department of Laboratory Medicine, AZ Delta General Hospital, Roeselare, Belgium
Anna Czyz
46Clinic of Hematology, Cellular Therapies and Internal Medicine, Wrocław Medical University, Wrocław, Poland
Veit Bücklein
Ludwig Maximilian University Hospital, Munich, Germany
Constance Baer
40MLL Munich Leukemia Laboratory, Munich, Germany
Costa Bachas
1Department of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
Sylvie D. Freeman
47School of Infection, Inflammation and Immunology, University of Birmingham College of Medicine and Health, Birmingham, United Kingdom
Francesco Buccisano
23Department of Biomedicine and Prevention, University of Rome tor Vergata, Rome, Italy
Christopher S. Hourigan
1Fralin Biomedical Research Institute, Virginia Tech Fralin Biomedical Research Institute Cancer Research Center, Washington, DC
Richard Dillon
5King's College London, London, United Kingdom
Michael Heuser