Dynamic Assessment of Measurable Residual Disease in Favorable-Risk Acute Myeloid Leukemia in First Remission, Treatment, and Outcomes

Purpose:We aimed to investigate outcomes of different post-remission treatment (PRT) choices based on dynamic measurable residual disease (MRD) in favorable-risk AML (FR-AML).

Methods: Four hundred and three younger patients with FR-AML in first complete remission (CR1) were enrolled in this registry-based cohort study, including 173 who received chemotherapy (CMT), 92 autologous stem cell transplantation (auto-SCT), and 138 allogeneic SCT (allo-SCT). Subgroup analyses were performed based on dynamic MRD after the first, second, and third courses of chemotherapy. The primary endpoint was the 5-year overall survival (OS).

Results: For patients with negative MRD after 1 course of chemotherapy, comparable OS was observed among the CMT, auto-SCT and allo-SCT groups (p=.284). But CMT had better graft-versus-host-disease-free, relapse-free survival (GRFS) than allo-SCT (p=.027). For patients with negative MRD after 2 courses of chemotherapy, comparable OS was also observed among the three groups (p=.967). However, CMT and auto-SCT had better GRFS than allo-SCT (p=.045; p=.020, respectively). For patients with negative MRD after 3 courses of chemotherapy, allo-SCT had better disease-free-survival than CMT (p=.011). However, OS was comparable among the three groups (p=.177). For patients with persistently positive MRD after 3 courses of chemotherapy or recurrent MRD, allo-SCT had better OS than CMT and auto-SCT (p=.012; p=.046, respectively).

Conclusions: Dynamic MRD might improve therapy stratification and optimize PRT selection for FR-AML in CR1. CMT might be preferable for patients with negative MRD within 3 cycles of chemotherapy while allo-SCT for patients with persistently positive MRD after 3 cycles of chemotherapy and recurrent MRD.