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Minimal Residual Disease (MRD) Analysis for B-ALL Test

DNA Labs India | ISO 9001:2015 Certified

Minimal Residual Disease (MRD) Analysis for B-ALL Test

Short Name: MRD B-ALL

Also known as: MRD B-ALL Test, Minimal Residual Disease Flow Cytometry, MRD Detection in B-ALL, Post-Treatment MRD Monitoring, Leukemia MRD Panel

Minimal Residual Disease (MRD) Analysis for B-ALL Test test available at DNA Labs India for ₹14,000. Uses Multicolor Flow Cytometry on Bone Marrow Aspirate samples. Results in Sample accepted daily by 9:00 AM. Report delivered on the next working day.. Free home collection in 300+ cities across India.

OncologistAll Ages🏠 Home Collection

✍️ Written By

🩺 Medically Reviewed By

Dr Pasupathy Arumugam

Dr Pasupathy Arumugam

Consultant Pathologist · Reg: 21521

Last reviewed: September 7, 2026

Overview

The primary purpose of MRD Analysis for B-ALL is to detect and quantify residual leukemic cells in the bone marrow that may be undetectable by conventional morphological examination. This test is essential for assessing the depth of remission after treatment, guiding risk-adapted therapy, predicting relapse risk, and informing decisions about treatment intensification or stem cell transplantation. Detection of MRD predicts outcome and is critical for risk assessment and stratification of therapy in B-ALL patients.

Test Code
1246
CPT Code
88184
ICD Code
C91.0
Price
₹14,000
Sample Type
Bone Marrow Aspirate
Result Time
Sample accepted daily by 9:00 AM. Report delivered on the next working day.
Fasting Required
No
Method
Multicolor Flow Cytometry
Step 1

Sample Collection

No specific patient preparation or fasting is required. However, it is mandatory to provide the date and time of sampling, the previous immunophenotype report, and relevant clinical history at the time of sample submission.

Method: Bone Marrow Aspiration

Step 2

Laboratory Analysis

Bone marrow aspirate is collected from the posterior iliac crest (or alternative site) by a trained physician. The first pull of the aspirate (3 mL minimum, 1 mL acceptable) is collected into a Green Top (Sodium Heparin) tube to prevent clotting and preserve cell viability for flow cytometry analysis.

Step 3

Report Delivery

The sample must be shipped immediately at room temperature (18-22°C). Do not refrigerate or freeze. Ensure the sample reaches the laboratory within 24 hours of collection. Label the sample clearly with patient identifiers and attach the requisition form with clinical history and prior immunophenotype report.

Timeline: Sample accepted daily by 9:00 AM. Report delivered on the next working day.

Patient Instructions

1
Before the Test:No fasting or special preparation is required from the patient. The bone marrow aspiration procedure will be performed by a trained physician. Ensure your doctor provides the previous immunophenotype report and clinical history along with the sample.
2
During the Test:A bone marrow aspiration is performed, typically from the posterior iliac crest under local anesthesia. The first pull of the aspirate is collected to minimize peripheral blood dilution. The procedure takes approximately 15-30 minutes. Mild discomfort may be experienced during aspiration.
3
After the Test:After sample collection, pressure is applied to the aspiration site. Patients may experience mild soreness at the collection site for 1-2 days. Avoid strenuous activity for 24 hours. Results will be available the next working day via online portal, email, or WhatsApp.

About This Test

Who Should Get This Test

The primary purpose of MRD Analysis for B-ALL is to detect and quantify residual leukemic cells in the bone marrow that may be undetectable by conventional morphological examination. This test is essential for assessing the depth of remission after treatment, guiding risk-adapted therapy, predicting relapse risk, and informing decisions about treatment intensification or stem cell transplantation. Detection of MRD predicts outcome and is critical for risk assessment and stratification of therapy in B-ALL patients.

How to Prepare

  • Collect 3 mL (1 mL minimum) of the first pull bone marrow aspirate in 1 Green Top (Sodium Heparin) tube
  • Ship the sample immediately at 18-22°C (room temperature)
  • DO NOT FREEZE the sample under any circumstances
  • Ensure sample reaches the laboratory within 24 hours of collection
  • Provide date and time of sampling on the requisition form
  • Attach previous immunophenotype report with the sample
  • Include detailed clinical history including treatment protocol and stage

Doctor's Notes

Reviewed by — MBBS, MD (Pathology) · Reg. No. 21521

"MRD assessment by flow cytometry is one of the most powerful prognostic tools we have in the management of B-ALL. Achieving MRD negativity after induction therapy is a critical milestone that guides decisions regarding treatment intensification, maintenance therapy, and the need for allogeneic stem cell transplantation. I strongly recommend MRD monitoring at defined treatment intervals for all B-ALL patients under my care."

Last medically reviewed: September 7, 2026

Test Parameters & Specifications

Sample TypeBone Marrow Aspirate
Sample Volume3 mL (1 mL min.) First pull Bone Marrow aspirate
Container1 Green Top (Sodium Heparin) tube
Collection MethodBone Marrow Aspiration

Sample Stability

Room Temperature (18-22°C)
Refrigerated (2-8°C)
Frozen (-20°C or below)
Sample Rejection Criteria:
  • Clotted sample (Sodium Heparin tube with visible clots)
  • Sample received frozen or at refrigerated temperature
  • Sample received more than 24 hours after collection
  • Sample volume less than 1 mL
  • Missing date and time of sampling on requisition form
  • Missing previous immunophenotype report
  • Sample collected in wrong anticoagulant (e.g., EDTA instead of Sodium Heparin)

Understanding Your Results

MRD results for B-ALL are reported as the percentage of leukemic cells detected among total nucleated cells in the bone marrow aspirate, based on the identification of aberrant immunophenotypic patterns relative to normal B-cell precursor maturation. A negative MRD result indicates absence of detectable residual disease at the test's sensitivity threshold (approximately 0.01%), while a positive result indicates the presence of residual leukemic cells and warrants clinical correlation and possible treatment modification.
📊

MRD Negative (< 0.01%)

Favorable prognosis. Associated with superior event-free survival and overall survival in B-ALL.

📊

MRD Positive (0.01% – 0.1%)

Increased risk of relapse compared to MRD-negative patients. Close monitoring and possible treatment modification advised.

📊

MRD Positive (> 0.1%)

High risk of relapse. Requires immediate clinical intervention and treatment intensification.

⚠️ When to Consult a Doctor:

Consult your hematologist or oncologist immediately if MRD-positive results are detected at any level. Additionally, consult your doctor if you experience symptoms suggestive of relapse such as unexplained fatigue, recurrent infections, fever, night sweats, easy bruising or bleeding, bone pain, swollen lymph nodes, or unintentional weight loss. Regular follow-up and MRD monitoring as recommended by your treating physician are essential for optimal disease management.

Limitations

  • ⚠Flow cytometry-based MRD analysis has a sensitivity limit of approximately 0.01%; disease burden below this threshold may not be detected
  • ⚠Immunophenotypic shift during treatment may cause loss of aberrant markers, potentially leading to false-negative MRD results
  • ⚠This test detects surface and intracellular markers but does not provide genetic or molecular information about the leukemic clone
  • ⚠Results should always be interpreted in conjunction with clinical findings, imaging, and other laboratory data
  • ⚠Adequate clinical history and prior immunophenotype report are essential for optimal test performance

Risks & Considerations

  • ●Mild pain or discomfort at the bone marrow aspiration site
  • ●Minor bruising or bleeding at the puncture site
  • ●Rare risk of infection at the aspiration site
  • ●Very rare risk of injury to surrounding structures during aspiration

Interfering Factors

  • ●Sample hemodilution (peripheral blood contamination of bone marrow aspirate) may yield falsely negative results
  • ●Delayed sample processing or improper storage temperature (sample must be maintained at 18-22°C)
  • ●Use of freeze-thawed specimens (DO NOT FREEZE bone marrow samples for this test)
  • ●Extensive prior therapy may alter the immunophenotype of leukemic cells, causing false-negative results
  • ●Previous immunophenotype report not provided, making it difficult to design patient-specific gating strategy
  • ●Insufficient sample volume (less than 1 mL) may compromise test sensitivity

Compare With Similar Tests

TestMinimal Residual Disease (MRD) Analysis for B-ALL TestBone Marrow Biopsy (Morphology)RT-PCR for Fusion TranscriptsNext-Generation Sequencing (NGS) for MRD
ComparisonMinimal Residual Disease (MRD) Analysis for B-ALL TestMorphological examination of bone marrow has a detection sensitivity of approximately 5%, meaning residual leukemic cells below this threshold go undetected. MRD flow cytometry analysis is approximately 500 times more sensitive, detecting cells at 0.01% level.RT-PCR for specific fusion transcripts (e.g., BCR-ABL1) can achieve sensitivity of 0.001% but is only applicable in cases with known molecular targets. MRD flow cytometry is broadly applicable regardless of the genetic subtype of B-ALL.NGS-based MRD detection offers high sensitivity and can track clonal immunoglobulin gene rearrangements. However, it is more expensive, has longer turnaround times, and is less widely available in India compared to flow cytometry.

Frequently Asked Questions

What is Minimal Residual Disease (MRD) in B-ALL?
Minimal Residual Disease (MRD) refers to the small number of cancer cells that may remain in the bone marrow or blood after treatment for B-cell Acute Lymphoblastic Leukemia (B-ALL). These residual cells are typically too few to be detected by standard microscopy but can be identified using highly sensitive techniques such as multicolor flow cytometry, which can detect as few as 1 leukemic cell among 10,000 normal cells.
Why is MRD testing important for B-ALL patients?
MRD testing is one of the most important prognostic tools in B-ALL management. It helps determine whether a patient has achieved a deep remission after treatment, guides decisions on whether to intensify or de-escalate therapy, identifies patients at high risk of relapse who may benefit from stem cell transplantation, and enables early detection of disease recurrence before clinical symptoms appear.
When should MRD testing be performed during B-ALL treatment?
MRD testing is typically performed at several defined time points: after induction therapy (around day 28-35), after consolidation therapy, before stem cell transplantation, and during maintenance therapy or long-term follow-up. The exact timing is determined by the treating oncologist based on the patient's treatment protocol and clinical status.
What sample is required for MRD Analysis for B-ALL?
The test requires a 3 mL (minimum 1 mL) first-pull bone marrow aspirate collected in a Green Top (Sodium Heparin) tube. The sample must be shipped immediately at room temperature (18-22°C) and must not be frozen. A first-pull aspirate is critical to minimize dilution with peripheral blood, which can affect test sensitivity.
What does MRD-negative result mean?
An MRD-negative result means that no residual leukemic B-lymphoblasts were detected at the test's sensitivity threshold of approximately 0.01%. This indicates a deep remission and is associated with a significantly lower risk of relapse. MRD-negative patients generally have better long-term outcomes and event-free survival.
What does an MRD-positive result mean?
An MRD-positive result indicates that residual leukemic cells were detected in the bone marrow. The clinical significance depends on the level of MRD: low-level positivity (0.01%-0.1%) may require closer monitoring or treatment modification, while higher levels (>0.1%) generally warrant treatment intensification or consideration for alternative therapies such as immunotherapy or stem cell transplantation. Your oncologist will interpret the result in the context of your overall clinical picture.
What is the sensitivity of MRD flow cytometry?
Multicolor flow cytometry-based MRD analysis at DNA Labs India achieves a sensitivity of approximately 0.01%, meaning it can detect 1 leukemic cell among 10,000 normal nucleated cells. This is significantly more sensitive than conventional bone marrow morphological examination, which has a sensitivity limit of approximately 5%.
Is the MRD Analysis for B-ALL test painful?
The test requires a bone marrow aspiration, which involves inserting a needle into the bone (typically the posterior iliac crest) under local anesthesia. Patients may feel a brief stinging sensation during anesthesia administration and pressure or dull ache during aspiration. Most patients tolerate the procedure well, and post-procedure soreness typically resolves within 1-2 days.
What is the cost of MRD Analysis for B-ALL in India?
At DNA Labs India, the MRD Analysis for B-ALL test is priced at Rs 14,000. This includes sample collection (where applicable), flow cytometry analysis by experienced professionals, and digital report delivery. This is a special discounted price available across India for online bookings.
Is the MRD Analysis for B-ALL test covered by insurance?
Coverage for MRD Analysis for B-ALL depends on your specific insurance policy, scheme, and provider. Government schemes such as PMJAY, CGHS, ECHS, and ESIC may cover this test under certain conditions. We recommend contacting your insurance provider or the relevant scheme authority for specific coverage details. DNA Labs India provides documentation to support insurance claims.
How long does it take to get MRD results?
At DNA Labs India, samples accepted daily by 9:00 AM will have reports ready by the next working day. Results are delivered via our online portal, email, or WhatsApp for patient convenience. Timely sample delivery to the laboratory is essential to meet this turnaround time.
Can MRD testing detect relapse before symptoms appear?
Yes, one of the key advantages of MRD testing is its ability to detect molecular or immunophenotypic relapse before clinical symptoms or hematological relapse becomes apparent. Early detection of rising MRD levels allows the treating oncologist to intervene promptly with appropriate therapy, potentially improving outcomes. This is why regular MRD monitoring during follow-up is strongly recommended for B-ALL patients.
Worried about the process? Our certified phlebotomists collect thousands of samples every month across India. The process takes under 5 minutes and is virtually painless. Questions? Message us on WhatsApp — we're here 7 days a week.

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