Computational measurable residual disease assessment in acute myeloid leukemia: a retrospective validation in the HOVON-SAKK-132 trial

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European Leukemia Net (ELN) guidelines recommend flow cytometry for widely applicable (~90% of patients) measurable residual disease (MRD) assessment in acute myeloid leukemia (AML) [ 1 ]. This immunophenotypic MRD is assessed by manual gating (mgMRD), which identifies leukemic cells based on manual inspection of two-dimensional plots. However, this process is time-consuming (>30 min per sample) and requires extensive standardization for reproducibility, particularly outside specialized laboratories [ 2 , 3 ]. The growing number of markers that can be evaluated together with spectral cytometry platforms exacerbates the analytical complexity, rendering mgMRD increasingly impractical [ 3 ].