Should MRD negativity post remission impact treatment decisions in ELN-intermediate risk AML?

During a meeting of the AML Hub Steering Committee, held on May 8, 2024, Jeffrey Lancet chaired a discussion on the question: In European LeukemiaNet (ELN) intermediate risk acute myeloid leukemia (AML), can or should measurable residual disease (MRD) assessment at the end of the treatment supersede baseline molecular risk stratification for determining next steps in treatment, for example, allogeneic bone marrow transplantation? The discussion featured Gail Roboz, Jordi Esteve, Jorge Sierra, and Roland Walter.

Lancet opens the discussion on whether MRD negativity post remission could replace transplantation in non-favorable risk AML settings. With advancements in the treatment landscape, cost concerns, and transplant-related comorbidities, such as graft-vs-host syndrome, some steering committee members supported sparing/delaying transplants for patients achieving MRD-negative remission, particularly after the first cycle of therapy. However, most opposed skipping transplants in intermediate-risk patients, except for specific genetic profiles. Concerns about the sensitivity of MRD measurement tools, especially flow cytometry, were also discussed. The lack of consensus highlights the need for more data and randomized trials.