{"entity":{"id":"ngs-mrd-clonoseq","kind":"technology","name":"NGS-based MRD (clonoSEQ and molecular MRD)","aka":[],"tldr":"Sequencing the unique genetic barcode of a patient's leukaemia to find one cancer cell in a million.","summary":"clonoSEQ (Adaptive Biotechnologies) tracks clonal IGH/TCR rearrangements at 10^-6 and is FDA-cleared for ALL, myeloma, and CLL. In AML, quantitative PCR of NPM1 or core-binding-factor fusion transcripts and error-corrected NGS of persistent mutations (excluding DNMT3A/TET2/ASXL1) define molecular MRD per ELN 2021. MRD status now drives transplant decisions in AML, blinatumomab use in ALL, and fixed-duration versus continuous therapy debates in CLL.","status":"standard-of-care","asOf":"2026-09-07","wikipedia":"https://en.wikipedia.org/wiki/Minimal_residual_disease","links":[{"label":"Wikipedia","url":"https://en.wikipedia.org/wiki/Minimal_residual_disease"},{"label":"van Dongen et al., Leukemia 2003: BIOMED-2 multiplex PCR for clonal immunoglobulin and T-cell receptor rearrangements","url":"https://doi.org/10.1038/sj.leu.2403202"}],"tags":[],"related":["mrd-kinetics-models"],"cancers":["aml","all-leukemia","cll","multiple-myeloma","non-hodgkin-lymphoma","dlbcl","mantle-cell-lymphoma"],"sections":["diagnostics"],"technologies":["mrd-testing","clonality-testing"],"targets":[],"drugs":[],"companies":["adaptive-biotechnologies"],"institutions":[],"pathways":[],"terms":["mrd","mrd-negative-cr"],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":["Lymphoma: the patient-specific immunoglobulin or T-cell receptor sequence found at diagnosis becomes the residual disease marker afterwards, which is why clonality testing and residual disease testing are the same assay read twice. The BIOMED-2 primer design is the ancestor of the sequencing versions (van Dongen 2003)."],"principle":"The assay deep-sequences a patient-specific clonotype or mutation with error correction.","strengths":["10^-5 to 10^-6 sensitivity","Blood-based monitoring in many settings"],"limitations":["Requires a baseline sample to identify the clone","Persisting pre-leukaemic clones (CHIP) confound AML MRD"]},"route":"/technologies/ngs-mrd-clonoseq/","neighbours":{"technology":[{"id":"clonality-testing","kind":"technology","name":"Immunoglobulin and T-cell receptor clonality testing","route":"/technologies/clonality-testing/"},{"id":"mrd-testing","kind":"technology","name":"MRD / molecular residual disease testing","route":"/technologies/mrd-testing/"},{"id":"mrd-kinetics-models","kind":"technology","name":"Residual disease kinetics (BCR-ABL halving and ctDNA slopes)","route":"/technologies/mrd-kinetics-models/"}],"cancer":[{"id":"all-leukemia","kind":"cancer","name":"Acute lymphoblastic leukaemia","route":"/cancers/all-leukemia/"},{"id":"aml","kind":"cancer","name":"Acute myeloid leukaemia","route":"/cancers/aml/"},{"id":"aya-cancers","kind":"cancer","name":"Adolescent and young adult cancers (ages 15 to 39)","route":"/cancers/aya-cancers/"},{"id":"cll","kind":"cancer","name":"Chronic lymphocytic leukaemia","route":"/cancers/cll/"},{"id":"dlbcl","kind":"cancer","name":"Diffuse large B-cell lymphoma","route":"/cancers/dlbcl/"},{"id":"aml-flt3","kind":"cancer","name":"FLT3-mutated acute myeloid leukaemia","route":"/cancers/aml-flt3/"},{"id":"all-paediatric-high-risk","kind":"cancer","name":"High-risk acute lymphoblastic leukaemia in children (high-risk B-ALL and T-ALL)","route":"/cancers/all-paediatric-high-risk/"},{"id":"mantle-cell-lymphoma","kind":"cancer","name":"Mantle cell lymphoma","route":"/cancers/mantle-cell-lymphoma/"},{"id":"multiple-myeloma","kind":"cancer","name":"Multiple myeloma","route":"/cancers/multiple-myeloma/"},{"id":"mds","kind":"cancer","name":"Myelodysplastic syndromes / neoplasms (MDS)","route":"/cancers/mds/"},{"id":"myeloproliferative-neoplasms","kind":"cancer","name":"Myeloproliferative neoplasms (PV, ET, myelofibrosis)","route":"/cancers/myeloproliferative-neoplasms/"},{"id":"myeloma-transplant-eligible","kind":"cancer","name":"Newly diagnosed multiple myeloma, transplant-eligible","route":"/cancers/myeloma-transplant-eligible/"},{"id":"myeloma-transplant-ineligible","kind":"cancer","name":"Newly diagnosed multiple myeloma, transplant-ineligible","route":"/cancers/myeloma-transplant-ineligible/"},{"id":"non-hodgkin-lymphoma","kind":"cancer","name":"Non-Hodgkin lymphoma (all types)","route":"/cancers/non-hodgkin-lymphoma/"},{"id":"aml-npm1-kmt2a","kind":"cancer","name":"NPM1-mutated and KMT2A-rearranged acute myeloid leukaemia","route":"/cancers/aml-npm1-kmt2a/"},{"id":"all-ph-like","kind":"cancer","name":"Philadelphia chromosome-like acute lymphoblastic leukaemia (Ph-like or BCR::ABL1-like ALL)","route":"/cancers/all-ph-like/"},{"id":"all-paediatric-ph-positive","kind":"cancer","name":"Philadelphia chromosome-positive acute lymphoblastic leukaemia in children (Ph-positive ALL)","route":"/cancers/all-paediatric-ph-positive/"},{"id":"all-paediatric-relapsed","kind":"cancer","name":"Relapsed and refractory acute lymphoblastic leukaemia in children","route":"/cancers/all-paediatric-relapsed/"},{"id":"all-paediatric-standard-risk","kind":"cancer","name":"Standard-risk B-cell acute lymphoblastic leukaemia in children","route":"/cancers/all-paediatric-standard-risk/"}],"section":[{"id":"diagnostics","kind":"section","name":"Diagnostics & Biomarkers","route":"/fronts/diagnostics/"}],"company":[{"id":"adaptive-biotechnologies","kind":"company","name":"Adaptive Biotechnologies","route":"/companies/adaptive-biotechnologies/"}],"term":[{"id":"b-all-cytogenetic-risk","kind":"term","name":"B-ALL risk groups (NCI criteria, ETV6::RUNX1, hyperdiploidy, hypodiploidy, iAMP21, IKZF1, CNS status)","route":"/terms/b-all-cytogenetic-risk/"},{"id":"mrd","kind":"term","name":"Minimal / molecular residual disease (MRD)","route":"/terms/mrd/"},{"id":"mrd-negative-cr","kind":"term","name":"MRD-negative complete remission","route":"/terms/mrd-negative-cr/"}],"trial":[{"id":"myelomatch","kind":"trial","name":"myeloMATCH","route":"/trials/myelomatch/"}],"idea":[{"id":"idea-mrd-guided-transplant-aml","kind":"idea","name":"MRD-guided transplant decisions in intermediate-risk AML","route":"/ideas/idea-mrd-guided-transplant-aml/"},{"id":"idea-mrd-guided-stop-cll","kind":"idea","name":"MRD-guided treatment duration in CLL","route":"/ideas/idea-mrd-guided-stop-cll/"},{"id":"idea-bio2-mrd-reference-standards","kind":"idea","name":"Reference materials and open proficiency testing for residual disease tests","route":"/ideas/idea-bio2-mrd-reference-standards/"},{"id":"idea-transplant-free-ph-all","kind":"idea","name":"Transplant-free Ph-positive ALL for MRD-negative adults","route":"/ideas/idea-transplant-free-ph-all/"},{"id":"idea-bio2-tcr-repertoire-early-readout","kind":"idea","name":"Watch the immune system's response in the blood three weeks in","route":"/ideas/idea-bio2-tcr-repertoire-early-readout/"}],"biomarker":[{"id":"ig-tcr-clonality","kind":"biomarker","name":"Immunoglobulin and T-cell receptor clonality","route":"/biomarkers/ig-tcr-clonality/"}],"bottleneck":[{"id":"b-dormancy-mrd","kind":"bottleneck","name":"Dormant cells and minimal residual disease","route":"/bottlenecks/b-dormancy-mrd/"}],"drug":[{"id":"clonoseq","kind":"drug","name":"clonoSEQ","route":"/drugs/clonoseq/"}]}}