MRD-Guided Decisions May Aid Postremission Treatment Choices in Type of AML

Making clinical decisions for patients with intermediate-risk acute myeloid leukemia (AML) based on their measurable residual disease (MRD) following remission may help facilitate better treatment optimization, according to a new study.

Based on subgroup analyses of over 500 younger patients (14-60 years) with intermediate-risk disease, the researchers say MRD-guided decisions may be associated with better treatment stratification and improved postremission treatment. They note that prospective multicenter trials are needed to validate these findings.

According to the researchers, while MRD has been widely adopted as a stratification tool for treatment, the association of dynamic MRD with treatment following remission in these patients is not well understood.

“It remains a challenge for practitioners to choose the optimal [postremission treatment] for patients with IR-AML because different conclusions have been drawn in previous reports,” explained the researchers, explaining that while some research has indicated that patients with intermediate-risk AML may fare better with allo-SCT, other research has indicated that chemotherapy or auto-SCT may yield better survival.

The study had a few important findings, including:

• Among patients who were MRD negative following induction therapy, those who received chemotherapy and auto-SCT achieved better graft-vs-host-disease–free, relapse-free survival (GRFS) than those who received allo-SCT
• Among patients who has persistent MRD and recurrent MRD, those who received allo-SCT had superior disease-free survival and overall survival (OS) than those who received auto-SCT or chemotherapy
• Among patients who achieved MRD negativity following 2 cycles of chemotherapy, those who received either type of SCT has better disease-free survival and OS compared with those receiving chemotherapy
• Among patients who achieved MRD negativity following 3 cycles of chemotherapy, those receiving allo-SCT had more favorable survival

Based on the findings, the researchers suggest: “[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. Auto-SCT prior to allo-SCT might be recommended for the patients who were MRD negative after 2 cycles of chemotherapy. Allo-SCT might be preferable for the patients who were MRD negative after 3 cycles of chemotherapy.”

Throughout the study period, 146 of the patients relapsed, with a median time from the first course of chemotherapy to relapse of 10.9 months. Patients receiving allo-SCT had the longest time to relapse with a median time to relapse of 13 months compared with a median 10.9 months among patients receiving auto-SCT and a median 9.9 months among patients receiving chemotherapy.

Reference

Yu S, Fan Z, Ma L, et al. Association between measurable disease in patients with intermediate-risk acute myeloid leukemia and first remission, treatment, and outcomes. JAMA Netw Open. 2021;4(7):e2115991.