# Multiparameter flow cytometry MRD

Source: https://onco.cc/technologies/flow-cytometry-mrd/  
OnCo record `flow-cytometry-mrd` (Technology). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Flow cytometry MRD counts leukaemia cells in the bone marrow one at a time by their surface proteins, down to one in ten thousand.

## Summary

Eight- to ten-colour flow detects leukaemia-associated immunophenotypes or 'different-from-normal' patterns at 10^-4 sensitivity. The most widely available MRD method in AML and ALL; ELN 2021 MRD guidelines define thresholds and timepoints. Next-generation flow (EuroFlow) reaches 10^-5 in myeloma and ALL. In CLL, undetectable MRD (<10^-4) after venetoclax combinations predicts long remission and is a regulatory endpoint.

## Fields

- Kind: Technology
- Status: standard-of-care
- Last checked: 2026-09-07
- Principle: Panels of fluorescently tagged antibodies distinguish aberrant blasts from regenerating normal precursors.
- Strengths: Broadly applicable, fast (same day); Works without a molecular marker
- Limitations: Operator and lab dependent; Sensitivity below molecular methods; immunophenotype shift after therapy

## Notes

- Lymphoma: flow gives an immunophenotype in hours on blood, marrow, cerebrospinal fluid, effusion or a fine-needle aspirate, and light-chain restriction is fast evidence of a clonal B-cell population. It is how circulating Sezary cells are counted and how marrow involvement is measured. It needs cells in suspension, so it cannot read a paraffin block, it reads a sclerotic node badly, it gives no architecture, and it under-detects classical Hodgkin lymphoma, where the malignant cells are rare and fragile.

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Flow_cytometry
- Wikipedia: https://en.wikipedia.org/wiki/Flow_cytometry

## Connected records

- technologies: [Cell-therapy release and potency testing](https://onco.cc/technologies/cell-therapy-release-testing/), [Flow cytometers](https://onco.cc/technologies/flow-cytometers/), [Immunoglobulin and T-cell receptor clonality testing](https://onco.cc/technologies/clonality-testing/), [MRD / molecular residual disease testing](https://onco.cc/technologies/mrd-testing/), [Residual disease kinetics (BCR-ABL halving and ctDNA slopes)](https://onco.cc/technologies/mrd-kinetics-models/)
- cancers: [Acute lymphoblastic leukaemia](https://onco.cc/cancers/all-leukemia/), [Acute myeloid leukaemia](https://onco.cc/cancers/aml/), [Acute myeloid leukaemia in children](https://onco.cc/cancers/aml-paediatric/), [Chronic lymphocytic leukaemia](https://onco.cc/cancers/cll/), [Chronic lymphocytic leukaemia, first treatment](https://onco.cc/cancers/cll-treatment-naive/), [Chronic myelomonocytic leukaemia and MDS/MPN overlap neoplasms](https://onco.cc/cancers/cmml/), [Cutaneous T-cell lymphoma (mycosis fungoides and Sezary syndrome)](https://onco.cc/cancers/cutaneous-t-cell-lymphoma/), [Hairy cell leukaemia](https://onco.cc/cancers/hairy-cell-leukemia/), [High-risk acute lymphoblastic leukaemia in children (high-risk B-ALL and T-ALL)](https://onco.cc/cancers/all-paediatric-high-risk/), [Indolent and smouldering systemic mastocytosis](https://onco.cc/cancers/indolent-systemic-mastocytosis/), [Leukaemia (all types)](https://onco.cc/cancers/leukaemia/), [Mantle cell lymphoma](https://onco.cc/cancers/mantle-cell-lymphoma/), [Marginal zone lymphoma](https://onco.cc/cancers/marginal-zone-lymphoma/), [Multiple myeloma](https://onco.cc/cancers/multiple-myeloma/), [Myelodysplastic syndromes / neoplasms (MDS)](https://onco.cc/cancers/mds/), [Newly diagnosed multiple myeloma, transplant-eligible](https://onco.cc/cancers/myeloma-transplant-eligible/), [Non-Hodgkin lymphoma (all types)](https://onco.cc/cancers/non-hodgkin-lymphoma/), [Peripheral T-cell lymphomas (including cutaneous T-cell lymphoma)](https://onco.cc/cancers/peripheral-t-cell-lymphoma/), [Philadelphia chromosome-like acute lymphoblastic leukaemia (Ph-like or BCR::ABL1-like ALL)](https://onco.cc/cancers/all-ph-like/), [Philadelphia chromosome-positive acute lymphoblastic leukaemia in children (Ph-positive ALL)](https://onco.cc/cancers/all-paediatric-ph-positive/), [Plasma cell leukaemia](https://onco.cc/cancers/plasma-cell-leukaemia/), [Relapsed and refractory acute lymphoblastic leukaemia in children](https://onco.cc/cancers/all-paediatric-relapsed/), [Relapsed or refractory chronic lymphocytic leukaemia](https://onco.cc/cancers/cll-relapsed/), [Sezary syndrome](https://onco.cc/cancers/sezary-syndrome/), [Standard-risk B-cell acute lymphoblastic leukaemia in children](https://onco.cc/cancers/all-paediatric-standard-risk/), [Systemic mastocytosis](https://onco.cc/cancers/systemic-mastocytosis/), [Waldenström macroglobulinaemia](https://onco.cc/cancers/waldenstrom/)
- fronts: [Diagnostics & Biomarkers](https://onco.cc/fronts/diagnostics/)
- companies: [BD (Becton, Dickinson and Company)](https://onco.cc/companies/becton-dickinson/), [Beckman Coulter](https://onco.cc/companies/beckman-coulter/)
- terms: [B-ALL risk groups (NCI criteria, ETV6::RUNX1, hyperdiploidy, hypodiploidy, iAMP21, IKZF1, CNS status)](https://onco.cc/terms/b-all-cytogenetic-risk/), [Minimal / molecular residual disease (MRD)](https://onco.cc/terms/mrd/), [MRD-negative complete remission](https://onco.cc/terms/mrd-negative-cr/)
- biomarkers: [Immunoglobulin and T-cell receptor clonality](https://onco.cc/biomarkers/ig-tcr-clonality/)
- bottlenecks: [Dormant cells and minimal residual disease](https://onco.cc/bottlenecks/b-dormancy-mrd/)
- ideas: [Select patients for cell therapy by whether their tumour holds reactive T cells](https://onco.cc/ideas/idea-bio2-til-reactivity-selection/)

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