Measurable residual disease predicts relapse, survival in AML

In acute myeloid leukaemia (AML) patients in their second complete morphological remission (CR2), measurable residual disease (MRD), in vivo T cell depletion, and the time from diagnosis to haematopoietic cell transplant (HCT) all seem to correlate with relapse and leukaemia-free survival (LFS), a recent study has found.

The study included 1,042 AML CR2 patients. At the time of HCT, 293 were MRD-positive (median age at transplant 49.8 years, 57.34 percent men) while the remaining 749 were MRD-negative (median age at transplant 49.4 years, 52.07 percent men). Two years after HCT, overall survival in the entire cohort was 62 percent while LFS was 54 percent.

Multivariate Cox regression analysis found that being MRD-negative at HCT significantly reduced the risk of relapse (hazard ratio [HR], 0.67, 95 percent confidence interval [CI], 0.44–0.73; p<0.001) and of developing extensive chronic graft-vs-host disease (HR, 0.57, 95 percent CI, 0.4–0.81; p=0.002). In turn, this led to better LFS (HR, 0.76, 95 percent CI, 0.62–0.94; p=0.01).

Similarly, the time from diagnosis to transplant was inversely associated with relapse (HR, 0.98, 95 percent CI, 0.97–0.99), leading to better LFS (HR, 0.99, 95 percent CI, 0.98–0.99). In vivo T cell depletion, on the other hand, was a significant risk factor for relapse (HR, 1.35, 95 percent CI, 1.02–1.79).

“Monitoring of MRD status peri-HCT is rapidly becoming standard clinical practice for patients with AML,” the researchers said. “However, international standardization of MRD assays will be key to future insights into the implications of MRD.”