Should the presence of minimal residual disease (MRD) in morphologic complete remission alter post-remission strategy in AML?

Minimal residual disease (MRD) monitoring, particularly via multiparameter flow (MPF) cytometry assessed after chemotherapy, has been very useful in the prognostic and therapeutic approach for children with acute lymphoblastic leukemia. While many studies suggest that MRD monitoring (using MPF or other techniques that are more sensitive than morphologic examination) might be able to accurately predict patient outcome, there is very little data suggesting that treatment decisions should be altered based on such measurements. Proving that MPF-defined MRD should prompt a change in treatment plan optimally requires a contemporaneous control group or at least a historical control treated in standard fashion.