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Can MRD Guide Postremission Treatment Decisions in Intermediate-Risk AML?

By: Sarah Campen, PharmD
Posted: Wednesday, August 25, 2021

Clinical decisions based on dynamic measurable residual disease (MRD) may be associated with improved therapy stratification and optimized postremission treatment for patients with intermediate-risk acute myeloid leukemia (AML), according to a study by Yu Zhang, MD, of Southern Medical University, Guangzhou, China, and colleagues. The results of this registry-based cohort study were published in JAMA Network Open.  

“It remains a challenge for practitioners to choose the optimal postremission treatment for patients with intermediate-risk AML because different conclusions have been drawn in previous reports,” commented the investigators. “Chemotherapy and auto-SCT might be preferable for the persistent MRD-negative patients, and allo-SCT should be strongly recommended for the persistent MRD-positive and recurrent MRD-positive patients.” However, they concluded, prospective multicenter trials are needed to further validate these findings.

The study included 549 patients, aged 14 to 60 years, from the South China Hematology Alliance database with newly diagnosed intermediate-risk AML; 154 patients received chemotherapy, 116 received an autologous stem cell transplant (auto-SCT), and 279 received an allogeneic stem cell transplant (allo-SCT). Subgroup analyses were performed according to the presence of MRD after one, two, or three courses of chemotherapy.

Patients who underwent chemotherapy and those who had auto-SCT had better outcomes (eg, graft-versus-host disease-free, relapse-free survival) than those who underwent allo-SCT (hazard ratio [HR] = 0.35 for chemotherapy; 0.07 for auto-SCT). In addition, among patients who achieved MRD after a single course of chemotherapy (but no MRD after two or three courses), those who underwent auto-SCT and allo-SCT had better outcomes (eg, lower cumulative incidence of relapse, better leukemia-free survival, and overall survival) than did those given chemotherapy alone.

Disclosure: The study authors reported no conflicts of interest.



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