Minimal residual disease (MRD) in childhood acute lymphoblastic leukemia (ALL) is now considered to be an equal, or greater, marker in predicting patient outcomes. MRD can aid in tailoring therapies according to initial treatment response. This risk-adapted approach to therapy has been shown to reduce the poor outcomes associated with high-risk subtypes of ALL. In this interview, Charles Mullighan, MBBS (Hons), MSc, MD, from St. Jude Childrens Research Hospital, Memphis, TN, highlights the importance of MRD monitoring and the new techniques that are being used to measure MRD in ALL patients, such as sequencing-based approaches. Recorded at the 2018 European School of Hematology (ESH) Clinical Updates on Acute Leukemias, held in Budapest, Hungary.