FRCPath Haem Part 1 EMQs-Oncology 84 and 85

Theme: Measurable Residual Disease (MRD) Monitoring in AML

Options

A. qPCR for NPM1 mutation

B. qPCR for RUNX1::RUNX1T1

C. qPCR for CBFB::MYH11

D. qPCR for PML::RARA

E. Multiparameter flow cytometry (MFC)

F. FLT3-ITD ultra-high sensitivity NGS

G. Bone marrow (BM) preferred over peripheral blood (PB)

H. Peripheral blood (PB) acceptable if blasts ≥20%

I. MRD monitoring not routinely recommended after 2 cycles

J. Post-allogeneic transplant MRD surveillance

Questions

1.

A 42-year-old woman with AML has a mutation in NPM1 without FLT3-ITD. The clinician wants the most appropriate MRD assay during remission monitoring.

2.

A patient with AML carrying RUNX1::RUNX1T1 fusion achieves morphological remission after induction therapy. Which MRD technique is preferred?

3.

A 29-year-old patient with acute promyelocytic leukaemia (APL) requires molecular MRD follow-up after completion of therapy.

4.

A patient with AML has FLT3-ITD and NPM1 mutation. The laboratory wants the most sensitive assay for FLT3 MRD assessment.

5.

A clinician asks whether peripheral blood can be used instead of bone marrow for MRD assessment in AML when blasts at diagnosis were markedly elevated (>20%).

6.

A patient with AML has no validated molecular marker available. Which MRD modality is most appropriate?

7.

A patient with CBFB::MYH11 AML is in complete remission. Which MRD assay should be used for longitudinal monitoring?

8.

A patient with PML::RARA-positive APL asks whether MRD testing is recommended after two cycles of treatment before HCT.

9.

A patient undergoes allogeneic stem cell transplantation for AML with high-risk molecular features. What is the key MRD strategy after transplant?

10.

A clinician requests the preferred specimen type for AML MRD monitoring because of higher sensitivity and reliability.