Use of Minimal Residual Disease in Acute Myeloid Leukemia Therapy
Sebastian Schwind1, Madlen Jentzsch1, Enrica Bach1
1Medical Clinic and Policlinic 1, Hematology and Cellular Therapy, Leipzig University Hospital, Liebigstrasse 22, Haus 7, 04103, Leipzig, Germany.
Opinion Statement:
The expanding availability of minimal or more precisely measurable residual disease (MRD) assessment in acute myeloid leukemia (AML) with its possible implications for therapeutic decisions is of high interest to clinicians treating AML patients. A variety of mostly retrospective studies have shown that AML patients with a positive MRD test, assessed by different techniques at defined cutoffs and time-points, are at significantly higher risk of relapse and experience shorter overall survival compared to MRD-negative patients. How this valuable information may be adapted in the daily routine of patients' treatment to distinguish individuals who need more aggressive therapy from the ones who can be spared additional therapy to avoid treatment-related toxicities is still being investigated. With the exception of MRD analyses in acute promyelocitic leukemia (APL), the clinical implications of MRD tests for the individual AML patient are still mostly unknown. We currently lack hard evidence that MRD-based therapy modulation during treatment or pre-emptive intervention in MRD-positive patients after therapy would improve outcomes in non-APL AML patients. These questions will be evaluated in prospective randomized clinical trials. Today, however, some conclusions with regard to MRD assessment in AML can be drawn from the published data and are reviewed in this article.
Insights
Measurable residual disease (MRD) testing in acute myeloid leukemia (AML) indicates higher relapse risk. However, its use in guiding AML treatment decisions requires further investigation in clinical trials.
Area of Science:
- Hematology
- Oncology
- Clinical Pathology
Background:
- Minimal or measurable residual disease (MRD) assessment is increasingly available for acute myeloid leukemia (AML) patients.
- Retrospective studies indicate positive MRD tests correlate with higher relapse risk and shorter survival in AML.
- The clinical utility of MRD in tailoring AML therapy remains under investigation.
Purpose of the Study:
- To review current conclusions on MRD assessment in AML based on published data.
- To discuss the potential implications of MRD for therapeutic decisions in AML.
- To highlight the need for prospective trials to validate MRD-guided treatment strategies.
Main Methods:
- Review of existing retrospective studies on MRD assessment in AML.
- Analysis of different MRD detection techniques and time-points.
- Evaluation of MRD status in relation to relapse risk and overall survival.
Main Results:
- Positive MRD status in AML is associated with significantly higher relapse rates.
- MRD-negative AML patients generally experience better overall survival.
- Clinical implications of MRD testing, except in acute promyelocytic leukemia (APL), are not yet fully established for individual patient management.
Conclusions:
- MRD assessment is a valuable prognostic tool in AML.
- Evidence is lacking to support routine MRD-based therapy modulation or pre-emptive intervention in non-APL AML.
- Prospective randomized clinical trials are necessary to determine the impact of MRD-guided treatment adjustments on AML patient outcomes.
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