Pretransplantation risk factors for positive MRD after allogeneic stem cell transplantation in AML patients: a
Si-Qi Li1, Chun-Zi Yu1, Lan-Ping Xu1
1Peking University People's Hospital & Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China.
Abstract:
We aimed to prospectively explore the risk factors for measurable residual disease (MRD) positivity after allogeneic stem cell transplantation (allo-SCT) in AML patients (n = 478). The cumulative incidences (CIs) of post-SCT MRD positivity at 100 days, 360 days and 3 years were 4.6%, 12.1% and 18.3%, respectively. Positive pre-SCT MRD and pre-SCT active disease were risk factors for post-SCT MRD positivity at both 360 days and 3 years (P < 0.001). European LeukemiaNet (ELN) 2017 risk stratification was a risk factor for positive post-SCT MRD at 360 days (P = 0.044). A scoring system for predicting post-SCT MRD positivity at 360 days was established by using pre-SCT MRD, pre-SCT active disease and ELN 2017 risk stratification. The CI of positive post-SCT MRD at 3 years was 13.2%, 23.7%, and 43.9% for patients with scores of 0, 1, and 2, respectively (P < 0.001). Multivariate analysis demonstrated that the scoring system was associated with a higher CI of post-SCT MRD positivity, leukemia relapse and inferior survival. Our data indicate that positive pre-SCT MRD status, pre-SCT active disease, and ELN 2017 risk stratification are risk factors for positive post-SCT MRD status in AML patients.
Insights
Measurable residual disease (MRD) positivity after allogeneic stem cell transplantation (allo-SCT) in AML patients is predicted by pre-transplant MRD, active disease, and ELN risk. This scoring system identifies patients at higher risk for relapse and poorer survival.
Area of Science:
- Hematology
- Oncology
- Stem Cell Transplantation
Background:
- Measurable residual disease (MRD) is a critical predictor of relapse after allogeneic stem cell transplantation (allo-SCT) in acute myeloid leukemia (AML).
- Identifying patients at high risk for post-transplant MRD positivity is essential for optimizing treatment strategies and improving outcomes.
Purpose of the Study:
- To prospectively identify risk factors for MRD positivity following allo-SCT in AML patients.
- To develop and validate a scoring system for predicting post-transplant MRD positivity.
Main Methods:
- Prospective study of 478 AML patients undergoing allo-SCT.
- Assessment of pre-transplant factors including MRD status, active disease, and European LeukemiaNet (ELN) 2017 risk stratification.
- Development of a scoring system based on identified risk factors.
Main Results:
- Cumulative incidences of MRD positivity at 100 days, 360 days, and 3 years were 4.6%, 12.1%, and 18.3%, respectively.
- Positive pre-transplant MRD and active disease were significant risk factors for post-transplant MRD positivity at 360 days and 3 years (P < 0.001).
- The developed scoring system effectively predicted 3-year MRD positivity, with cumulative incidences of 13.2%, 23.7%, and 43.9% for scores 0, 1, and 2, respectively (P < 0.001).
Conclusions:
- Pre-transplant MRD status, active disease, and ELN 2017 risk stratification are key predictors of post-transplant MRD positivity in AML.
- The established scoring system is associated with increased MRD positivity, leukemia relapse, and inferior survival.
- This scoring system can aid in risk stratification and personalized treatment approaches for AML patients undergoing allo-SCT.
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