EBMT 2024 | Integrating genomics and MRD in transplant decision-making for patients with AML

Yeah, so at EBMT, my talk was about integrating genomics and MRD in transplant decision making. And in that talk I spoke about the indications for allogeneic transplant specifically for patients with acute myeloid leukemia, where we balance the risk or the decision for transplant based on the disease risk and the transplant risk. And there are several methods which you can use to assess those risks. And importantly for disease, it’s needed to use classification systems, and MRD. And the classification systems we’re currently using are based on genomics, so molecular assessment of the leukemia and cytogenetic alterations as assessed by karyotyping. And by doing that you’ll identify several risk groups where it’s quite clear for the favorable risk population, especially those with MRD negative leukemia, that transplant is not the way to go. And that transplant is specifically important for those patients who are either having an adverse risk leukemia or having MRD positivity after induction treatment.

And in previous analyzes, we’ve shown that transplant is actually beneficial for every leukemia patient. So irrespective of the risk of the disease by the genomics, we found that, there is a reduction in relapse risk with the transplant compared to non-transplant treatments, and it’s actually quite similar. And about one third, or 2.5 fold reduction in relapse by transplantation. And the same applied for MRD. So MRD negative patients and MRD positive patients have the same relative reduction of relapse. But it’s important to realize that for a favorable risk patient it’s actually relatively low your relapse risk even without a transplant. And then the absolute benefit of a transplant is only about 20%, in long term outcome. And if you consider the risks of a transplant in terms of non relapse mortality, that actually needs to be outperformed by the transplant. So therefore I suggested in my talk that for the favorable risk patients, especially MRD negative no transplant. And for the patients with a much higher risk, you should definitely consider transplantation. And the most important subgroup is the intermediate risk subgroup where you can actually go both ways. And in that subgroup, MRD is of very much importance. And I think MRD negative patients will behave like a favorable risk patient, whereas intermediate MRD positive patients will behave like an adverse risk patients. And therefore that MRD should specifically for intermediate risk patients determine how those patients should be consolidated.