On August 22–23, 2025, the 13th Lu Daopei Hematology Conference was held in Beijing, jointly organized by the Beijing Health Promotion Association and the Guangzhou Kapok Oncology and Rare Disease Foundation, and hosted by the Beijing Lu Daopei Hematology Institute. The conference brought together world-leading experts in hematology and focused on hematopoietic stem cell transplantation, cellular therapy, and precision medicine in hematologic malignancies. With more than a thousand participants, the event offered a high-level, in-depth academic exchange. During the meeting, Professor Hui Wang from Hebei Yanda Lu Daopei Hospital and Beijing Lu Daopei Hospital delivered an important presentation on recent advances in flow cytometry–based detection of minimal residual disease (MRD) in acute myeloid leukemia (AML). Oncology Frontier – Hematology News invited Professor Wang to provide further insights into this critical area, offering practical guidance for clinical management.PART 1
MRD monitoring plays a vital role in prognosis and guiding individualized treatment strategies in AML. What do you consider the most significant advances in flow cytometry for MRD detection in recent years, and how have these developments improved clinical decision-making?
Professor Hui Wang: Acute myeloid leukemia, the most common form of acute leukemia, places extraordinary importance on MRD detection for prognosis and treatment planning. At the same time, it is also one of the most technically challenging assays.
The challenges mainly arise from two aspects. First, AML cells are typically not monoclonal and show high heterogeneity. Antigen expression is complex and unstable, with immunophenotypic shifts over time, making accurate identification and quantification of MRD difficult. Second, the bone marrow microenvironment contains normal hematopoietic stem cells and myeloid precursors. Distinguishing malignant blasts from this large background of normal cells is another major difficulty.
Despite these challenges, important progress has been made. Since 2018, the European LeukemiaNet (ELN) has issued expert consensus recommendations on AML MRD detection, and in 2021 further released technical consensus guidelines specifically for flow cytometry. These guidelines have advanced standardization and consistency in practice, even though their recommended protocols are relatively simplified.
On the technical side, significant improvements have also occurred. The number of markers has increased, instruments have become more precise, and panel designs more complex, all of which have enhanced information content and resolution. Furthermore, research into leukemic stem cells and their interactions with the immune microenvironment has enriched MRD strategies.
At the same time, with the rise of CAR-T therapy and the broader era of immunotherapy, flow cytometry has played an irreplaceable role in identifying tumor-specific targets. If markers can be identified that are highly specific to tumor cells yet minimally expressed in normal cells—or whose toxicities can be technically circumvented—this would drive forward targeted therapy.
Therefore, MRD detection in AML is increasingly incorporating novel targets, opening promising avenues for both diagnosis and therapy.
PART 2
Interpreting flow cytometry data, particularly high-dimensional datasets, has long been a challenge for precision diagnostics. In AML MRD detection, what are your views on data standardization, automated analysis tools (such as AI-assisted methods), and consistency in reporting? Can these approaches help resolve the variability seen between laboratories?
Professor Hui Wang: In flow cytometry–based MRD detection for AML, standardization, harmonization, and the application of intelligent analysis tools are essential directions for both current practice and long-term development. Whether in a three-year or five-year horizon—or even longer—these remain priority goals.
That said, AML MRD testing continues to face significant challenges, largely because of the inherent heterogeneity of the disease itself. Current detection panels are not yet optimal, and most laboratories still use marker combinations with limited coverage. Under such conditions, it is not yet feasible to rely on artificial intelligence for routine analysis.
Encouragingly, the field has recognized these limitations. Work is ongoing to expand marker coverage, systematically screen and optimize panels, and move detection strategies into higher dimensions. High-dimensional analysis depends heavily on advances in multiparameter flow cytometry. By increasing the number of fluorochromes, assays that once required two or three tubes can now be consolidated into a single tube, exponentially increasing the information obtained.
Ultimately, multidimensional data analysis is the goal of ultramultiparameter flow cytometry, but this will only be achieved gradually, through large-scale data collection, iterative optimization, and algorithmic refinement—similar to the way dimensionality reduction and clustering methods have evolved. Progress will come not in a single step, but through sustained, systematic research.
PART 3
Based on your experience at Lu Daopei Hospital, what are the greatest challenges or most urgent areas for advancement in AML MRD detection? How do you and your team plan to explore and optimize these directions in the future?
Professor Hui Wang: At Lu Daopei Hospital, we continue to pursue in-depth research in AML flow cytometry detection. AML accounts for about half of our daily test volume, which aligns with its relatively high incidence.
From a treatment standpoint, unlike T-ALL and B-ALL—where CAR-T therapy has well-established targets—targeted therapies in AML remain largely experimental. Given its high incidence, large sample base, and suboptimal treatment outcomes, AML compels us to keep refining MRD strategies and searching for broader and more effective targets.
Our current focus is twofold: improving the sensitivity of MRD detection and enhancing the identification of leukemic stem cells. These efforts aim to support the development of future CAR-T or other targeted therapies by providing novel targets and research evidence.
To this end, we are pursuing two approaches: continuously adding new markers and designing more efficient panel combinations. Emerging technologies such as mass cytometry and full-spectrum flow cytometry have provided powerful support for high-dimensional panel design, greatly accelerating the advancement of ultramultiparameter detection.
Looking ahead, breakthroughs in AML are likely to come from integrating three dimensions: MRD detection and target screening at the level of leukemic blasts, identification of leukemic stem cells, and comprehensive analysis of the immune microenvironment. The ultimate goal is to create multiparameter, individualized diagnostic and therapeutic strategies. Given the marked heterogeneity of antigen expression in AML patients, future practice may involve grouping patients by immunophenotypic features to achieve truly personalized therapy.
Expert Profile
Professor Hui Wang Vice President, Beijing Lu Daopei Hematology Institute Deputy Director, Department of Laboratory Medicine (Vice President–level), Hebei Yanda Lu Daopei Hospital / Beijing Lu Daopei Hospital
Professor Wang has more than 24 years of experience in flow cytometry and hematology diagnostics. She serves as Editorial Board Member of the Chinese Journal of Laboratory Medicine, Youth Editorial Board Member of the Chinese Journal of Hematology, Chair of the Flow Cytometry Committee of the Chinese Association of Integrative Medicine, Vice Chair of the Hematology Diagnostic Committee of the Chinese Association of Medical Education, and Vice President of the Beijing Society of Laboratory Medicine, among over 20 academic positions.
She holds 10 Chinese invention patents and 2 U.S. invention patents. As corresponding author, she has published six national expert consensus statements on flow cytometry and co-authored nine others. She has also published more than 60 papers in SCI-indexed and core journals as first or corresponding author.
