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MRD as predictor of late relapses after transplant in AML or MDS/AML
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Allo-HCT offers an important curative-intent treatment option for adult patients with AML following chemotherapy-induced remission.1 Pre-HCT MRD testing identifies patients with AML at high risk of relapse, which often occurs early post-HCT.1 To investigate the role of MRD testing in predicting later relapses, Ali et al.1 conducted a retrospective study in 935 patients with AML or MDS/AML who underwent HCT in first or second CR, with bone marrow restaging between Day +70 and +100, and who remained alive and relapse-free by Day +100. Their findings were published in Blood Advances.1 |
| Key learnings |
| 15% of patients were MRD+ pre-HCT, whilst only 1% were MRD+ at Day 70–100 post-HCT. Among patients alive without relapse at Day +100, MRD is uncommon but identifies patients at increased risk of relapse and reduced survival. |
| Patients who were MRD+ pre-HCT had a significantly higher risk of relapse and lower RFS and OS vs those who were MRD− (all p < 0.001), with no significant difference in NRM (p = 0.32 and p = 0.43, respectively). |
| Although 92% of pre-HCT MRD+ patients converted to MRD− at Day 70–100 post-HCT, 3-year outcomes were significantly worse than patients MRD− pre- and post-HCT, with relapse risk of 40% vs 15% (p < 0.001), RFS of 50% vs 72% (p < 0.001), and OS of 56% vs 76% (p < 0.001). |
| The results highlight the need for post-HCT pre-emptive therapies for patients with pre-HCT MRD. Further studies are needed to evaluate the potential of peri-HCT “MRD conversion” as a surrogate endpoint in clinical trials. |
Abbreviations: allo-HCT, allogeneic hematopoietic cell transplantation; AML, acute myeloid leukemia; CR, complete remission; HCT, hematopoietic cell transplantation; MDS, myelodysplastic syndromes; MRD, measurable residual disease; NRM, non-relapse mortality; OS, overall survival; RFS, relapse-free survival.
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