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Peri-transplant conundrums: optimizing maintenance therapy using MRD-directed approaches.

Suravi Raychaudhuri1,2, Ryan D Cassaday1,2, Mary-Elizabeth M Percival1,2

  • 1Division of Hematology and Oncology, Department of Medicine, University of Washington, Seattle, WA.

Hematology. American Society of Hematology. Education Program
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Summary
This summary is machine-generated.

Advances in detecting measurable residual disease (MRD) in acute leukemia allow for monitoring post-transplant. Targeted therapies show promise for MRD-positive patients, but optimal interventions require further study.

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Area of Science:

  • Hematology
  • Molecular Biology
  • Oncology

Background:

  • Molecular insights have improved detection of measurable residual disease (MRD) in acute leukemia.
  • Next-generation sequencing and PCR assays detect MRD at levels as low as 10^-6.
  • Detectable MRD around allogeneic hematopoietic cell transplantation (HCT) correlates with poor outcomes and relapse risk.

Purpose of the Study:

  • To review the role of maintenance therapy in acute leukemia, focusing on MRD-positive patients before and after HCT.
  • To discuss current strategies for targeting MRD in specific acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL) contexts.

Main Methods:

  • Literature review of studies on MRD detection and management in acute leukemia.
  • Analysis of therapeutic strategies for MRD-positive patients undergoing or following HCT.
  • Focus on specific agents like azacitidine, gilteritinib, sorafenib, blinatumomab, and tyrosine kinase inhibitors.

Main Results:

  • Post-HCT azacitidine may benefit MRD-positive AML.
  • Gilteritinib and sorafenib are evidence-based for MRD in FLT3-mutated AML post-HCT.
  • Blinatumomab is effective for MRD eradication in Ph+ and Ph-negative ALL; TKIs are used for Ph+ ALL post-HCT.

Conclusions:

  • Significant progress has been made in targeting MRD in acute leukemia peri-HCT.
  • Optimal duration and type of intervention for peri-HCT MRD remain undefined for many patients.
  • Further research is needed to establish definitive treatment guidelines for MRD management.