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Prognostic impact of MRD clearance timing in patients with newly diagnosed AML undergoing intensive chemotherapy
Whilst the prognostic value of MRD in AML is well established, the ideal timing for achieving undetectable MRD remains unclear.1 The prognostic impact of MRD after induction and after subsequent chemotherapy cycles in patients with newly diagnosed AML was evaluated in a retrospective study at The University of Texas MD Anderson Cancer Center between 2010 and 2021 (N = 1,980).1 Jen et al.1 conducted a retrospective analysis of data from this study for patients who achieved remission with frontline intensive chemotherapy with MRD assessment following induction (TP1) and following Cycles 2 or 3 (TP2) (n = 277) to assess the relationship between MRD status at different time points and survival outcomes, and provide insights into MRD assessment timing and its implications for treatment strategies, including the potential benefit of SCT in intermediate-risk AML. Cases were grouped into MRD−/ MRD− (n = 187), MRD+/MRD− (n = 43), or MRD+/MRD+ (n = 47) at TP1 and TP2, respectively.1 The findings were published in Blood Advances.1
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| Key learnings |
| Early MRD negativity was associated with significantly improved RFS and OS vs positive MRD at induction or after subsequent chemotherapy. The 5-year RFS rates were 53%, 33%, and 13% for the MRD−/MRD−, MRD+/MRD−, and MRD+/MRD+ groups, respectively (p = 0.05). |
| The median OS was 81 months, 40 months, and 9 months, respectively (p < 0.01), but the difference between MRD−/MRD− and MRD+/MRD− was not statistically significant (p = 0.19). The 5-year OS rates were 54%, 48%, and 28%, respectively. |
| Patients with intermediate-risk AML who achieved uMRD after induction still benefited from consolidative SCT, highlighting the importance of SCT regardless of MRD clearance timing. |
| MRD clearance timing can serve as an important prognostic factor, indicating when treatment intensification may be necessary. However, MRD alone may be insufficient to determine the appropriateness of SCT, as SCT improved outcomes in many patients regardless of MRD status. |
Abbreviations: AML, acute myeloid leukemia; MRD, measurable residual disease; MRD+, MRD, positive; MRD−, MRD-negative; OS, overall survival; RFS, relapse-free survival; SCT, stem cell transplant; TP1, time point 1; TP2, time point 2; uMRD, undetectable MRD.
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