ASH 2022 | MRD status vs treatment intensity in predicting the outcome of patients with AML

So this is of particular interest to me because I actually think that this may be the way we will be going in the future. Once we have a very reliable, sensitive MRD assay, I think achieving deep MRD-negative status at very deep levels should become the goal of therapy and could potentially become a surrogate for long-term survival. Of course, we need to have studies to show this.

This is a retrospective study that looked at a large number of patients in our institution who had been treated either with intensive therapy without venetoclax or with lower-intensity regimens plus venetoclax. The hypothesis was that if you achieve a MRD-negative status and the MRD was assessed by flow cytometry with a sensitivity of less than 0.1% or better, the hypothesis was if you achieve such a MRD negative status with the lower intensity regimens plus venetoclax or similar relapse-free survival and potentially overall survival than similar patients who received intensive therapy.

Of course, there’s imbalances in the two populations. The intensive therapy was mainly used in younger, fitter patients who had more favorable ELN category and are generally considered to be more responsive to chemotherapy.

But I think the take home message from the study was that a multivariate analysis, the intensity of therapy, which is either chemo or lower intensity plus venetoclax, was not one of the multivariate factors. Whereas achieving a response, CR versus lesser responses than CR or achieving MRD-negative status, as well as ELN subtype, were predictors of both relapse-free and overall survival.