ELN 2025 MRD Update Introduces Risk-Stratified Response Categories and NGS Standards for AML
This 2025 update from the ELN-DAVID MRD Working Party provides 56 consensus recommendations for MRD assessment in AML, aligned with the ELN 2022 genetic classification. Key innovations include a qualitative MRD response category (optimal/warning/high-risk), subgroup-specific MRD guidance, and endorsement of ultra-high-sensitivity NGS for FLT3-ITD MRD after intensive chemotherapy and before transplant. The guidelines represent a major step toward harmonised, clinically actionable MRD reporting.
The original study
2025 update on MRD in acute myeloid leukemia: a consensus document from the ELN-DAVID MRD Working Party.
- Authors
- Cloos J, Valk PJM, Thiede C, Döhner K, Roboz GJ, Wood BL, et al.
- Journal
- Blood
- Type
- Journal Article, Review, Practice Guideline
- PMID
- 41397238
Original 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.