Hematologist
CION Cancer Clinics
Minimal residual disease: the number after treatment | CION Cancer Clinics
MRD testing looks for tiny amounts of blood cancer left after treatment, far too few to see under a microscope. A negative result means none were found at the test's limit; a positive one means some cells remain. It helps your haematologist decide whether to continue, change or add treatment. It shifts the odds but cannot, on its own, tell you what will happen. At CION Cancer Clinics, our haematologist reviews abnormal blood reports with you, orders only the tests that answer your question and explains each result plainly.
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Medically reviewed by Dr. Basudev PokhrelConsultant Haematologist · last reviewed September 2026, next review due September 2027
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On this page
- What is MRD testing, and why is it done after treatment?
- Which tests are used to measure MRD?
- When during treatment is MRD usually checked?
- What do MRD negative and MRD positive usually mean?
- Which MRD words will you see on the report?
- What do families often misunderstand about MRD?
- What can an MRD result not tell you?
- Common questions about MRD testing
The short answer
What is MRD testing, and why is it done after treatment?
MRD testing looks for tiny amounts of blood cancer left after treatment, far too few to see under an ordinary microscope. MRD stands for minimal or measurable residual disease. The result helps your haematologist judge how deeply the treatment has worked and what should come next.
Why remission is not the whole story
Remission means the usual tests no longer show leukaemia in the blood or marrow. But a marrow can look normal under the microscope and still hold a small number of cancer cells. MRD tests are sensitive enough to find one abnormal cell hidden among tens of thousands of normal ones, and some go further still.
Where it is used most
MRD testing is now part of care for acute lymphoblastic leukaemia (ALL), many cases of acute myeloid leukaemia (AML), chronic lymphocytic leukaemia and myeloma. In chronic myeloid leukaemia, a similar idea is tracked with a regular blood test called BCR-ABL1 PCR.
Who may not have it
MRD testing needs a marker in your cancer cells that the laboratory can follow. If no suitable marker was found at diagnosis, the test may not be possible or may be less reliable. Some lymphomas are followed with scans instead. Older adults on gentler treatment may also be followed with counts and marrow checks alone, because an MRD result would not change what the team offers.
How it is measured
Which tests are used to measure MRD?
Your report will name the method. Each has strengths, and results from different methods are not always directly comparable.
Flow cytometry
A machine checks the surface markers on a very large number of cells and picks out the ones with the leukaemia's pattern. It is widely available and reports relatively quickly.
Often used for
- ALL and AML
- Myeloma
PCR
Looks for a specific gene change or fusion known to be in your leukaemia. When a suitable target exists, it can be very sensitive and easy to track over time.
Often used for
- NPM1-changed AML
- BCR-ABL1 in CML and some ALL
NGS-based MRD
Reads the unique genetic fingerprint of your cancer cells and searches for it in later samples. It can be highly sensitive, but it is available in fewer laboratories.
It usually needs a sample from diagnosis to know what to look for.Not sure whether this applies to you?
Ask an oncologistThe pathway
When during treatment is MRD usually checked?
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At diagnosis
The laboratory records the marker it will follow later. Without this starting point, later MRD results can be harder to read.
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After the first phase of treatment
The first MRD check usually comes with the marrow test at the end of induction, the first intensive phase. This result often shapes the next phase.
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During later treatment
Further checks may be planned at set points. A falling or undetectable level is what the team hopes to see.
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Before a transplant
If a transplant is planned at a partner centre, an MRD result before it helps the transplant team plan.
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During follow-up
In some blood cancers, MRD is repeated at intervals after treatment ends, to spot a rise before symptoms appear.
Reading the result
What do MRD negative and MRD positive usually mean?
MRD negative
MRD positive
No cancer cells found at the test's level of sensitivity
A small number of cancer cells still detected
Generally linked with a lower chance of return
Generally linked with a higher chance of return
Treatment usually continues as planned
The team may change or add treatment
Does not mean every cancer cell is gone
Does not mean treatment has failed
On your report
Which MRD words will you see on the report?
- Sensitivity
- How small an amount of cancer the test can find. A more sensitive test can see fewer cells.
- Undetectable
- Nothing was found at that test's limit. It is not proof of zero.
- Limit of detection
- The smallest amount the laboratory can reliably report for that sample.
- Molecular response
- A PCR-based measure, used in CML and some AML, of how far the gene marker has fallen.
- Sample quality
- A diluted marrow sample, mixed with blood, can make a result less reliable. Reports sometimes comment on this.
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Commonly believed
What do families often misunderstand about MRD?
"MRD negative means the cancer can never come back."
It is very good news, and it is still not a promise. The test has a limit below which it cannot see. That is why follow-up continues even after a negative result.
"MRD positive means the treatment did not work."
A positive result after a first phase often means the disease has responded but not yet deeply enough. Many people go on to become negative with further treatment the team plans.
"We can compare this result with a report from another laboratory."
Different methods and laboratories have different sensitivities. Ideally MRD is tracked with the same method each time. Ask before switching laboratories.
"If MRD is negative, the remaining treatment can be skipped."
Never stop or shorten treatment on your own. Some plans are adjusted on MRD results, but only the treating team can make that decision.
Being straight with you
What can an MRD result not tell you?
An MRD result cannot tell you exactly what will happen. It shifts the odds, and your haematologist uses it with everything else they know about your disease and your health.
It is one result in a series
A single MRD number is most useful when read against earlier and later ones. A one-off borderline result may be repeated before anything changes. Try not to react to a single report before it has been explained.
Waiting for results is hard
MRD reports can take longer than a routine blood count, especially when samples are sent to a specialist laboratory. CION does not run every MRD method in-house. The haematology team arranges testing with qualified laboratories and discusses the result at a tumour board.
What to ask
Ask which method was used and how sensitive it is. Ask whether the same method will be used next time, and what the plan would be if the result is positive or negative. Knowing that in advance makes the wait easier.
Looking after yourself while you wait
Keep your usual appointments and blood tests, and report any fever, bleeding or new tiredness as you normally would. Those signs matter more in the moment than a pending MRD report. If the worry is getting on top of you, tell the team. Talking it through is part of care.
Questions we are asked
Common questions about MRD testing
Is MRD done on blood or bone marrow?
For most acute leukaemias and myeloma, bone marrow gives the most reliable result, because small amounts of disease hide there first. In chronic myeloid leukaemia, the PCR test is usually done on blood. Your haematologist will tell you which sample your disease and method need.
Does an MRD test mean another marrow procedure?
Usually it is taken during a marrow test that is already planned to check response. Extra samples are drawn at the same time, so a separate procedure is not normally needed. Local numbing is used, and you can ask about additional pain relief beforehand.
My MRD went from negative to positive. What happens now?
Contact your haematologist promptly and do not change any medicine yourself. The team may repeat the test to confirm it, check other results and discuss whether treatment should change. A rising MRD can sometimes be treated before the disease shows in the blood count at all.
Is MRD testing needed for lymphoma?
For most lymphomas, response is usually checked with a PET-CT scan and clinical examination instead. MRD blood tests for lymphoma are being studied, and a few centres use them in specific situations. Ask your team whether it applies to your type.
Why did the report say the sample was not adequate?
Sometimes the marrow sample is diluted with blood, or too few cells reach the laboratory. That can make a negative result less trustworthy. It is not anyone's fault. Your team may decide to repeat the sample or rely more on the next scheduled test.
Can MRD results decide whether I need a transplant?
They are one of several things that feed into that decision, along with the risk group, your age and fitness and whether a donor is available. CION does not perform transplants, but the team will explain whether referral makes sense and help coordinate it.
Is MRD testing covered by insurance or schemes?
It varies. Some cashless insurance policies and government schemes such as Aarogyasri, PM-JAY, CGHS, ECHS and EHS may cover it as part of approved treatment. Rules change, so check the current rules with your insurer or the scheme desk before the sample is sent.
Can my child have MRD testing too?
Yes. MRD testing is a standard part of care for childhood acute lymphoblastic leukaemia, and it is often used to decide how intensive later treatment should be. The team treating your child will explain when samples are taken and how the results change the plan.
Your Haematologist
Meet CION's haematologist. One specialist for your blood report and your plan.
Dr. Basudev Pokhrel reviews blood counts, transfusion needs and blood disorders, and works with the CION tumour board on blood cancers.
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Sources
- National Cancer Institute — Definition of minimal residual disease
- American Cancer Society — Acute Lymphocytic Leukemia (ALL) in Adults
- Cancer Research UK — Acute lymphoblastic leukaemia (ALL)
- Leukemia & Lymphoma Society — Leukemia
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
MRD Negative but Still AnxiousWhat a negative result does and does not rule outFlow Cytometry in Blood Cancer: What It DecidesThe most common method behind an MRD resultRisk Stratification: Favourable, Intermediate, AdverseHow MRD and the risk group work togetherLeukaemia guideThe wider picture of leukaemia care
Talk to us
Have an MRD result you want explained?
Share the report or call the helpline. The haematology team will go through what it means and what to ask next. One helpline serves every CION centre.