Testing for residual leukemia
Physician-scientist Jesse Tettero is part of a national effort to improve and standardize detection of residual disease after leukemia treatment. A Postdoctoral Excellence Award will support his work.
This year, 22,000 Americans will be diagnosed with acute myeloid leukemia, an aggressive blood cancer.
Many respond well to chemotherapy and appear to achieve complete remission. But even when standard tests indicate that the cancer has cleared, not all of these patients will survive.
“At the end of treatment, there may still be just a few leukemia cells hiding among a million healthy cells,” said Jesse Tettero, a Virginia Tech postdoctoral associate conducting research at the Fralin Biomedical Research Institute's Cancer Research Center in Washington, D.C. “If those cells survive, the cancer can return in an aggressive way, so we need extremely sensitive tests to find them early.”
Tettero’s research focuses on better understanding remission and relapse in acute myeloid leukemia. With the support of a 2025-26 Lyerly Postdoctoral Excellence Award, he will continue to develop tools that help physicians identify high-risk patients sooner.
Before joining the lab of Christopher Hourigan, director of the research institute's Cancer Research Center — D.C., Tettero trained as a medical doctor in the Netherlands. His clinical background shapes his approach to science.
“For me, the best part of medicine has always been caring for patients,” he said. “But there are only 24 hours in a day, and as a clinician, you can help only a limited number of people face-to-face. Through research, you can add an extra layer of impact. Your work can ultimately reach far more patients than you could ever treat individually. Even if it helps just one person, that is reason enough to keep going.”
A central tool in Tettero’s work is multiparameter flow cytometry, a laboratory technique that analyzes individual cells by passing them through a laser-based instrument. In leukemia, abnormal combinations of cell-surface markers distinguish cancerous blood cells from healthy ones. These subtle abnormalities point to measurable residual disease (MRD), the minute amount of cancer cells that can remain after treatment.
While flow cytometry is widely available and used for MRD testing, its accuracy heavily depends on how samples are collected, which markers are used, the instrumentation, and the skill of the person interpreting the data.
“Protocols differ significantly between centers,” Tettero said. “A test optimized for a facility in Washington, D.C., may not perform exactly the same in Seattle. That variability matters when you’re looking for a few cells in a million.”
To help address this variability, Tettero works closely with the Center for International Blood and Marrow Transplant Research, a nationwide registry that gathers clinical and laboratory data from transplant centers across the United States. Shortly after joining the Hourigan Lab in August 2024, he was invited to join the center’s task force working to harmonize MRD testing practices nationwide.
“Ultimately, I hope that insights from these studies will help refine relapse prediction and guide treatment decisions in patients with acute myeloid leukemia, wherever that patient might be,” Tettero said.
More sensitive and reliable detection methods could enable oncologists to recognize relapse earlier, when the disease is easier to treat. Identifying these patterns is a step toward ensuring that MRD testing provides consistent, actionable information for every patient. But Tettero notes that optimizing flow cytometry alone will likely not be enough.
As a result, his work is increasingly shifting toward molecular MRD approaches, particularly next-generation sequencing and whole-genome sequencing. These DNA-based technologies can detect persistent cancer-associated mutations at far lower levels than traditional methods, opening a promising path toward earlier, more precise relapse prediction.
"Tettero demonstrates the qualities of an exceptional postdoctoral researcher: intellectually independent, clinically insightful, and deeply committed to impactful translational science,” said Hourigan, whose lab is internationally recognized in next-generation sequencing and whole-genome sequencing. “His research is already beginning to realize its profound potential to improve detection sensitivity and potentially save lives.”
The award will support Tettero's participation in scientific conferences, including annual meetings of the American Society of Hematology and the European Hematology Association, as well as professional development courses offered by the NIH Office of Intramural Training and Education and the National Postdoctoral Association.
The Lyerly Postdoctoral Excellence Awards are funded by a gift from Mary Denton Roberts and David Lyerly, himself a former Virginia Tech postdoctoral fellow. The annual award recognizes postdoctoral trainees at the Fralin Biomedical Research Institute whose research proposals show potential for novel scientific contributions.
