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Cancer still present after treatment but too small to see on scans, detected by blood or marrow tests.
Minimal or molecular residual disease (MRD), also called measurable residual disease, is cancer that persists after treatment at a level too small to see on scans but detectable in blood or marrow; a negative result is called molecular remission. In leukaemia and myeloma it is measured by flow cytometry or NGS of marrow (clonoSEQ); in solid tumours it means ctDNA after surgery, covered under MRD / molecular residual disease testing. MRD positivity predicts relapse, MRD-guided escalation (IMvigor011) and de-escalation (DYNAMIC) are proven concepts, and MRD is an accepted endpoint in myeloma trials (FDA ODAC 2024). Readers meet it in the Colorectal, Pancreatic, Bladder & urothelial, DLBCL and Multiple myeloma entries and in CIRCULATE-Japan.
Showing the technology this term belongs to: MRD / molecular residual disease testing.
The glossary entry explains the word; the readout page carries the scoring rule, the thresholds approvals use, the companion diagnostics and the tests.
Residual-disease testing may not need the tumour to be sequenced first, which would remove the slowest step of tumour-informed assays; the comparison with tumour-informed results in the same patients is the evidence that matters.
Together with the JCO Precision Oncology cohort this makes residual disease testing in biliary cancer prognostic to the same degree as in colon cancer. Nobody has yet shown that acting on it helps; that is the trial gap the ideas on this page name.
AMPLIFY delivered the first all-oral, fixed-duration doublet for front-line CLL and supported its approval, giving fit patients a way to avoid both chemotherapy and years of continuous BTK inhibitor. It does not settle whether a doublet or triplet is best, or how AV compares with venetoclax-obinutuzumab. Patients with TP53 aberration were excluded and still need different strategies.
AALL1731 brings immunotherapy into the front-line treatment of the commonest childhood cancer, in the group of children where most relapses were occurring despite good initial risk. Blinatumomab was approved for this use in 2024 and paediatric protocols worldwide are being amended. Whether it can allow less chemotherapy, and its effect on very low-risk children, are the next questions.
Very wide confidence intervals from a small cohort, but the direction matches the larger 2026 analysis. Gallbladder cancer recurs early and distantly after re-resection, which is exactly the setting where a residual disease test could pick who gets more than capecitabine.
After bladder removal, a blood test can now tell who needs immunotherapy and who can safely be spared it. This is the model for MRD-guided adjuvant therapy across cancers: treat the blood-positive, watch the blood-negative.
Adjuvant treatment for lung cancer is now chosen by genotype. A resected ALK-positive tumour is treated with two years of a tablet instead of four cycles of platinum, which is a different life as well as a different outcome.
E1910 changed the standard of care for adult B-ALL: immunotherapy is now part of front-line consolidation even for patients with no detectable leukaemia, because MRD-negative by flow cytometry does not mean cured. It also demonstrated that a T-cell engager can improve overall survival in a curative setting. Chemotherapy-light or chemotherapy-free regimens built on blinatumomab and inotuzumab are the next step.
Shares ESMO recommendations on the use of circulating tumour DNA assays for patients with cancer: a report from the ESMO Precision Medicine Working Group, Tracking early lung cancer metastatic dissemination in TRACERx using ctDNA, c-TRAK TN analysis: tissue-free versus tumour-informed ctDNA assays for residual disease in early triple-negative breast cancer, Take the blood test, and give the drug, at the right time of day and the tag precision.
Shares ESMO recommendations on the use of circulating tumour DNA assays for patients with cancer: a report from the ESMO Precision Medicine Working Group, Maximilian Diehn, c-TRAK TN analysis: tissue-free versus tumour-informed ctDNA assays for residual disease in early triple-negative breast cancer, Personalis (Tempus) and the tag precision.
Shares ESMO recommendations on the use of circulating tumour DNA assays for patients with cancer: a report from the ESMO Precision Medicine Working Group, Bank yearly blood from cancer survivors so future tests can be validated, Tumour-informed versus tumour-naive ctDNA assays, Cell-free DNA (cfDNA) and the tag precision.
Shares Personalis (Tempus), BCL2 G101V and the other venetoclax binding-site mutations, INCLIVA Biomedical Research Institute / Hospital Clínico Universitario de Valencia, National Cancer Center Hospital East and the tag precision.
Shares Maximilian Diehn, The metastatic cascade, Precision roadmap: margins measured in millimetres → tests that find a target → doses fitted to the person → precision that changes outcomes, Metastasis is understood least and studied last and the tag precision.
Shares Sylvester Comprehensive Cancer Center, University of Miami, Cancer Center Clínica Universidad de Navarra / CIMA, National Cancer Center Hospital East, Precision roadmap: margins measured in millimetres → tests that find a target → doses fitted to the person → precision that changes outcomes and the tag precision.
Shares Prophylactic cranial irradiation for patients with small-cell lung cancer in complete remission, Lung cancer (all types), Triple-negative breast cancer (TNBC) and the tag precision.
Shares Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation, Resectable pancreatic ductal adenocarcinoma, Bladder & urothelial cancer, Lung cancer (all types) and the tag precision.