AML: Monitor Early MRD to Optimize Outcomes

TOPLINE:

Early clearance of measurable residual disease (MRD) after induction therapy in patients with acute myeloid leukemia (AML) is associated with significantly better relapse-free survival (RFS) than those with delayed clearance. Patients achieving MRD negativity after induction had a median RFS of 73 months vs 22 months for those achieving it later.

METHODOLOGY:

Researchers conducted a retrospective study of 1980 newly diagnosed patients with AML treated with intensive chemotherapy at The University of Texas MD Anderson Cancer Center in Houston between 2010 and 2021.
The analysis included 277 patients who achieved complete remission or complete remission with incomplete hematologic recovery after induction and had flow cytometry MRD assessments at both timepoints.
A multiparameter flow cytometry panel comprising CD34, CD38, CD117, CD33, CD13, CD123, HLA-DR, and other markers was used to assess MRD with a sensitivity of 10^–3 to 10^–4.
Patients were categorized into three groups based on MRD status: Negative/negative (n = 187), positive/negative (n = 43), and positive/positive (n = 47) at timepoint 1 and timepoint 2.

TAKEAWAY:

Median RFS significantly differed among MRD groups: 73 months for negative/negative, 22 months for positive/negative, and 5 months for positive/positive groups (P < .01), with a significant difference between negative/negative and positive/negative groups (P = .05).
On multivariable analysis, positive/negative MRD status was independently associated with worse RFS compared with negative/negative status (hazard ratio, 1.73; 95% CI, 1.09-2.75; P = .02).
Allogeneic stem cell transplantation (SCT) benefited patients regardless of MRD status, with a median RFS of 116 months vs 11 months for nontransplant patients (P < .01).
Early MRD negativity was most discriminatory in patients aged < 60 years, those treated with intensive chemotherapy plus venetoclax, and patients who did not undergo allogeneic SCT.

IN PRACTICE:

“In conclusion, undetectable flow MRD after induction is associated with better RFS than undetectable MRD achieved later during consolidation. SCT benefited patients with intermediate-risk AML, regardless of MRD kinetics,” the authors of the study wrote.

SOURCE:

This study was led by Wei-Ying Jen, MD, at The University of Texas MD Anderson Cancer Center in Houston. It was published online on February 25 in Blood Advances.

LIMITATIONS:

According to the authors, the study included only patients in complete remission or complete remission with incomplete hematologic recovery after induction, limiting its applicability to those with suboptimal responses. The analysis excluded patients with treated secondary AML and core-binding factor AML, restricting generalizability to these subgroups. Additionally, the study selected only patients with clear positive/negative MRD status, leaving uncertainty about outcomes in patients with indeterminate MRD status.

DISCLOSURES:

This study was supported in part by the MD Anderson Cancer Center Leukemia Specialized Programs of Research Excellence grant CA100632. Jen reported no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.