Prognostic impact of complete remission with MRD negativity in patients with relapsed or refractory AML
Nicholas J Short1, Hind Rafei2, Naval Daver1
1Department of Leukemia.
Abstract:
In relapsed/refractory acute myeloid leukemia (AML), the prognostic impact of complete remission (CR) and measurable residual disease (MRD) negativity is not well established. We retrospectively analyzed 141 patients with relapsed/refractory AML who received first salvage therapy and had MRD assessed by multiparameter flow cytometry at the time of response. Patients who achieved CR with full hematologic recovery as best response vs those with incomplete hematology recovery had lower cumulative incidence of relapse (P = .01) and better relapse-free survival (P = .004) but not overall survival (P = .15); a similar trend was observed in patients who achieved MRD negativity vs those who were MRD positive (P = .01, P = .05, and P = .21, respectively). By multivariate analysis, CR and MRD negativity were each independently associated with lower cumulative incidence of relapse (P = .001 and P = .003, respectively) and better relapse-free survival (P < .001 and P = .02) but not overall survival. Patients who achieved CR with MRD negativity had the lowest rates of relapse and best survival (2-year overall survival rate, 37%), which was driven largely by lower rates of early relapse and an increased ability in this group to undergo hematopoietic stem cell transplantation (HSCT); however, post-HSCT outcomes were similar regardless of response to salvage chemotherapy. Overall, in patients with relapsed/refractory AML, CR with MRD negativity was associated with the best outcomes, supporting it as the optimal response in this setting.
Insights
Complete remission (CR) with measurable residual disease (MRD) negativity after salvage therapy offers the best prognosis for patients with relapsed/refractory acute myeloid leukemia (AML). This response is linked to lower relapse rates and improved survival outcomes.
Area of Science:
- Hematology
- Oncology
- Clinical Research
Background:
- Prognostic significance of complete remission (CR) and measurable residual disease (MRD) negativity in relapsed/refractory acute myeloid leukemia (AML) remains unclear.
- Salvage therapy is a critical treatment option for patients with relapsed/refractory AML.
Purpose of the Study:
- To evaluate the prognostic impact of CR and MRD negativity following first salvage therapy in relapsed/refractory AML.
- To determine the optimal response criteria for predicting outcomes in this patient population.
Main Methods:
- Retrospective analysis of 141 patients with relapsed/refractory AML receiving first salvage therapy.
- Measurable residual disease (MRD) assessment using multiparameter flow cytometry at the time of response.
- Statistical analysis including univariate and multivariate models to assess outcomes.
Main Results:
- CR with full hematologic recovery and MRD negativity were independently associated with a lower cumulative incidence of relapse and better relapse-free survival.
- Patients achieving CR with MRD negativity demonstrated the lowest relapse rates and best overall survival (2-year OS: 37%).
- Achieving CR with MRD negativity facilitated hematopoietic stem cell transplantation (HSCT), but post-HSCT outcomes were similar regardless of pre-HSCT response.
Conclusions:
- Complete remission with measurable residual disease negativity represents the optimal response in relapsed/refractory AML treated with salvage therapy.
- This response status is a strong predictor of improved relapse-free survival and overall survival.
- Further research may focus on optimizing salvage strategies to achieve CR with MRD negativity.
More Related Videos
08:31Murine Model of Leukemia Relapse to Induction Chemotherapy for Acute Lymphoblastic Leukemia
Published on: October 17, 2025
09:01Flow Cytometry to Estimate Leukemia Stem Cells in Primary Acute Myeloid Leukemia and in Patient-derived-xenografts, at Diagnosis and Follow Up
Published on: March 26, 2018