Minimal Residual Disease Identifies Patients Who May Benefit from HCT in First Complete Remission

In this study of 2,450 younger adult patients with acute myeloid leukemia (AML) or high-risk myelodysplastic syndromes (MDS), researchers prospectively measured minimal residual disease (MRD) status using multiparameter flow cytometry after each course of induction chemotherapy to evaluate the predictive value of risk stratification.

Patient responses were categorized as resistant disease (RD), partial remission (PR), and complete remission (CR), with the CR cohort subdivided by flow cytometry assay into MRD+ and MRD-.

Survival outcomes from PR and MRD+ responses after induction were comparable, particularly for good- to standard-risk subgroups: 5-year overall survival (OS), 27% RD vs. 46% PR vs. 51% MRD+ vs. 70% MRD-; p<0.001.

The researchers found that MRD positivity appeared less discriminatory in poor-risk patients by stratified analyses. For an NPM1-wt standard-risk subgroup, MRD+ after a second induction was significantly associated with poorer outcomes (OS, 33% vs. 63% MRD-, p=0.003; relapse incidence, 89% when MRD+ ≥0.1%). Transplant benefit was more apparent in patients with MRD+ (HR, 0.72; 95% CI, 0.31 to 1.69) than for those with MRD- (HR, 1.68 [95% CI, 0.75 to 3.85]; p=0.16 for interaction).

The researchers concluded that MRD assessments using multiparameter flow cytometry “can improve outcome stratification by extending the definition of partial response after first induction and may help predict NPM1-wt standard-risk patients with poor outcome who benefit from transplant in the first CR.”

Freeman SD, et al. J Clin Oncol

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