Molecular MRD by qPCR: current guidelines for intensive chemotherapy and questions pertaining to less intensive venetoclax-based regimens. (A) Current European LeukemiaNet guidelines for monitoring molecular NPM1 MRD testing for patients with NPM1 mutations who are undergoing intensive induction chemotherapy regimens, though questions remain as outlined by the diagram. (B) There are no current guidelines for recommendations for MRD testing for patients with NPM1 mutations receiving non-intensive venetoclax-baesd regimens. The diagram depicts current questions that exist surrounding monitoring NPM1 molecular MRD testing in this treatment setting. ∗Existing data have indicated that patients with MRD following induction chemotherapy may benefit from transplant, but approaches in this situation are not standardized. ∗∗Preemptive therapy is recommended by ELN guidelines, but preemptive approaches are not standardized. Potential approaches include immediate transplant vs salvage therapy with either intensive chemotherapy or less intensive approaches for MRD eradication followed by potential transplant in appropriate candidates. Patients are encouraged to enroll in clinical trials. ˆPreemptive therapy could include immediate transplant vs salvage therapy for MRD eradication followed by potential transplant in appropriate candidates.

Molecular MRD by qPCR: current guidelines for intensive chemotherapy and questions pertaining to less intensive venetoclax-based regimens. (A) Current European LeukemiaNet guidelines for monitoring molecular NPM1 MRD testing for patients with NPM1 mutations who are undergoing intensive induction chemotherapy regimens, though questions remain as outlined by the diagram. (B) There are no current guidelines for recommendations for MRD testing for patients with NPM1 mutations receiving non-intensive venetoclax-baesd regimens. The diagram depicts current questions that exist surrounding monitoring NPM1 molecular MRD testing in this treatment setting. ∗Existing data have indicated that patients with MRD following induction chemotherapy may benefit from transplant, but approaches in this situation are not standardized. ∗∗Preemptive therapy is recommended by ELN guidelines, but preemptive approaches are not standardized. Potential approaches include immediate transplant vs salvage therapy with either intensive chemotherapy or less intensive approaches for MRD eradication followed by potential transplant in appropriate candidates. Patients are encouraged to enroll in clinical trials. ˆPreemptive therapy could include immediate transplant vs salvage therapy for MRD eradication followed by potential transplant in appropriate candidates.

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