Precision medicine results from equitable representation.

Area of Science:

• Hematology
• Oncology
• Transplantation Science

Background:

• Measurable residual disease (MRD) is an emerging biomarker for predicting relapse in acute myeloid leukemia (AML) post-hematopoietic cell transplantation (HCT).
• Specific genetic mutations, including IDH1, IDH2, and FLT3-TKD, are being investigated for their impact on MRD detection and clinical outcomes.
• Current research cohorts predominantly represent non-Hispanic White (NHW) populations, raising concerns about generalizability and health equity.

Purpose of the Study:

• To evaluate the predictive value of pre-hematopoietic cell transplantation (HCT) measurable residual disease (MRD) related to IDH1, IDH2, and FLT3-TKD mutations for acute myeloid leukemia (AML) relapse.
• To examine the implications of racial and ethnic disparities in access to HCT and HCT-related research.
• To propose strategies for enhancing diversity and representation in precision medicine initiatives within HCT.

Main Methods:

• Retrospective analysis of patient data from clinical practice and research biobanks.
• Assessment of measurable residual disease (MRD) status for IDH1, IDH2, and FLT3-TKD mutations prior to allogeneic HCT.
• Analysis of patient demographics, focusing on racial and ethnic composition of the study cohorts.

Main Results:

• Pre-HCT MRD status for IDH1, IDH2, and FLT3-TKD mutations demonstrates potential in predicting AML relapse after allogeneic HCT.
• The studied patient populations were overwhelmingly non-Hispanic White (84-86%), indicating significant underrepresentation of other racial and ethnic groups.
• This lack of diversity highlights potential inequities in access to HCT and participation in precision medicine research.

Conclusions:

• Pre-transplant MRD markers are important predictors of AML relapse, but their impact may not be uniform across diverse populations.
• Significant racial and ethnic disparities exist in access to HCT and related research, potentially hindering the equitable application of precision medicine.
• Strategies are needed to promote inclusivity and representation in HCT research to ensure that advances in precision medicine benefit all patient groups.