How can we apply MRD guidelines to low-intensity therapy in AML?

During a meeting of the AML Hub Steering Committee, held on May 8, 2024, Jeffrey Lancet chaired a discussion on the question: How can we apply minimal residual disease (MRD) guidelines to low-intensity therapy in acute myeloid leukemia (AML)? The discussion featured contributions from Gail Roboz, Naval Daver, and Uwe Platzbecker.

The steering committee members discuss how MRD negativity can serve as a prognostic tool for guiding treatment decisions in AML, including low-intensity therapy (e.g., hypomethylating agents, venetoclax), maintenance therapy (including gilteritinib), transplantation, treatment modification, and extended drug holidays, in both fit and older/frail patients. The steering committee members highlighted the limitations of existing MRD assessment methods, such as the sensitivity of flow cytometry, assay quality, NPM1, FLT3, NGS PCR assays, and RNA fusion panels. The group also previewed the upcoming European LeukemiaNet risk guidelines on MRD monitoring and potential opportunities to learn about experiences in other diseases, such as acute and chronic lymphoblastic leukemia.