Advancing Research
Minimal Residual Disease and Lymphoma Scientific Symposium
Minimal residual disease (MRD) is the persistence or re-emergence of detectable tumor cells after cancer treatment. A quantitative definition, however, remains elusive, as more effective therapies have increasingly reduced tumor burden, while increasingly sensitive MRD tests have enabled lower and lower thresholds of detection. It is now widely agreed that MRD has prognostic value, but optimal application in clinical and research settings remains unclear, largely due to broad heterogeneity between trial designs, patient populations, therapeutic regimens, and disease subtypes. This latter variable is particularly relevant in lymphoma, as subtypes of disease present diverse biological characteristics that may impact the utility of MRD testing.
Chaired by Andrew D. Zelenetz, MD, PhD (Memorial Sloan Kettering Cancer Center), the Lymphoma Research Foundation’s inaugural 2023 MRD and Lymphoma Scientific Symposium, experts convened to discuss the state of MRD science and technology, current research findings and possible treatment implications, the emerging role of MRD in clinical trial design, regulatory considerations, pharmaceutical industry perspectives, current gaps, future directions, and next steps.
Throughout the symposium, participants explored these challenges while highlighting the significant opportunities MRD presents for improving patient outcomes and accelerating therapeutic innovation.
Discussions spanned the full landscape of MRD research, from advances in next-generation sequencing and circulating tumor DNA technologies to the practical realities of implementing testing in clinical trials and routine practice. Experts reviewed lessons learned from diseases such as chronic myeloid leukemia, multiple myeloma, chronic lymphocytic leukemia, and pediatric acute lymphoblastic leukemia, where MRD has already transformed approaches to risk assessment and treatment monitoring. These experiences offered valuable insights into how the lymphoma community might build a similar framework for standardized testing and clinical integration.
A major focus of the meeting centered on the growing body of evidence supporting MRD as a prognostic biomarker across multiple lymphoma subtypes, including follicular lymphoma, mantle cell lymphoma, anaplastic large cell lymphoma, and large B-cell lymphoma. Participants examined how MRD may complement existing tools such as imaging, provide earlier indications of treatment effectiveness, and help identify patients at increased risk of relapse. At the same time, speakers emphasized that the biology of lymphoma is highly heterogeneous, and that disease-specific approaches will be necessary to ensure MRD testing delivers meaningful and actionable information.
The symposium also highlighted the increasing role of MRD in clinical research. Investigators reviewed ongoing studies using MRD to guide treatment duration, inform response-adapted strategies, and serve as an endpoint in clinical trials. Particular attention was given to the promise of circulating tumor DNA–based approaches, which may offer a more sensitive measure of residual disease than conventional imaging and could ultimately support faster evaluation of new therapies. Participants discussed both the opportunities and challenges associated with incorporating MRD into future trial designs, including the need for assay harmonization, standardized reporting criteria, and robust evidence demonstrating clinical benefit.
Throughout the meeting, a recurring theme was the importance of collaboration. Advancing MRD from a promising research tool to a broadly accepted clinical and regulatory endpoint will require coordinated efforts among academic investigators, industry partners, regulatory agencies, and patient advocacy organizations. Participants emphasized the need for common definitions, standardized methodologies, shared data resources, and prospective studies capable of establishing how MRD should be used across different lymphoma settings.
The symposium concluded with a forward-looking discussion focused on defining priorities for the field. While significant challenges remain, there was broad consensus that MRD has the potential to reshape how lymphoma is monitored, how therapies are evaluated, and how future clinical trials are conducted. By bringing together diverse stakeholders around a common goal, the International MRD and Lymphoma Scientific Symposium laid the groundwork for future initiatives aimed at accelerating progress and ultimately improving outcomes for people living with lymphoma.