JL517. Minimal Residual Disease in Hematological Malignancies: Implications for Practice
Mickey Stiger Register, FNP-BC, MSN, MPH, Genentech, Jennifer Giarratana, MSN, ANP, AOCNP®, Genentech, and Colleen Weber, BSN, RN, Genentech
© 2018 Harborside™
JADPRO Live at APSHO 2017
Marriott Marquis, Houston, Texas • November 2–5, 2017
The posters for the abstracts below can be found at:
Background: As advanced practice providers (APP), it is essential to determine the optimal management of a patient with a hematological malignancy. The efficacy of treatment options are evaluated in clinical trials using common endpoints, such as, overall survival, progression-free survival, and response rate. A review of more recent clinical trials and publications of hematological malignancies reveals there is an emerging focus on minimal residual disease (MRD) negativity as a secondary endpoint. MRD describes the lowest presence of malignant cells that are detectable using available methods. After completing treatment, a patient is deemed MRD negative when there is an absence of malignant cells by analysis using current sensitive testing modalities. In several hematologic cancers, MRD negativity is considered the single most predictor of overall survival and is therefore an important component of patient management.
Intervention: It is important for APPs to be aware of MRD as an endpoint in clinical trials for some hematologic malignancies. Understanding of the methods of measuring MRD will assist in comprehending the analysis of trial data. This information may assist in guiding treatment decisions and patient management, ultimately influencing practice implications.
Findings: MRD analysis requires testing of blood, bone marrow, and/or lymph nodes. The methodologies for MRD evaluation, including morphology, cell culture assays, karyotoypic analysis, fluorescence in situ hybridization (FISH) techniques; flow cytometry and immunophenotypic analyses; and molecular analyses (Southern blotting and PCR), will provide valuable clinical knowledge.
Summary: Understanding MRD methodologies and data analysis in clinical trials will assist the APP in managing patients with hematologic malignancies. This also provides the foundation for a thoughtful patient discussion regarding the prognosis and treatment options. In clinical practice, the presence or absence of residual disease may be a useful measurement in determining a patient’s response to treatment.
Implications: In some hematologic malignancies the presence of MRD after the completion of treatment has been shown to be associated with early relapse. Understanding this may be helpful in establishing the patient’s molecular response to therapy and options for future treatment. At this time, the majority of MRD testing is performed in clinical trials and further study for clinical application to general oncology practice is suggested in the literature. Yet, there is an increasing amount of discussion of MRD status in patient education literature and APPs should familiarize themselves with MRD as part of both disease management, patient monitoring, and discussion.
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