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EHA 2026 | Molecular profiling and MRD are reshaping transplant decision-making in AML
Arnon Nagler, MD, Chaim Sheba Medical Center, Tel-Aviv, Israel, discusses the growing importance of integrating molecular profiling and measurable residual disease (MRD) assessment into transplant decision-making for acute myeloid leukemia (AML). Prof. Nagler explains how genomic and MRD data are increasingly guiding risk stratification, transplant eligibility, and relapse monitoring in modern AML care. This interview took place at the 31st Congress of the European Hematology Association (EHA) in Stockholm, Sweden.
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Transcript
Yes, so the field of ML is really moving and the prognostication and the consultation of patients for transplant is based today on a mutation profile and the MRD. So at the beginning, the consultation and referring patient to transplant was based mainly on cytogenetics. But then when we have the mutation, we even change the classification of the AML according to LeukemiaNet 2022 for patients that receive intensive induction...
Yes, so the field of ML is really moving and the prognostication and the consultation of patients for transplant is based today on a mutation profile and the MRD. So at the beginning, the consultation and referring patient to transplant was based mainly on cytogenetics. But then when we have the mutation, we even change the classification of the AML according to LeukemiaNet 2022 for patients that receive intensive induction. And in 2024 for patients that receive non-intensive inductions or patients with venetoclax plus azacitidine. So really the mutation profile is dissecting the ML and the decision to go to transplant is based on the mutation profile. And moreover, MRD is a very important prognostic factor and many studies have shown that patients that have a positive MRD pre-transplant do worse. And so the combination of mutation and MRD really dictates the result of transplantation. And we should monitor MRD. And the MRD monitoring, according to a consensus paper that was published in Blood in 2022, is really, you know, whether to do it with peripheral blood or bone marrow and the cutoff point and the technique is flow or next-generation sequencing, which depends on the mutation, so the mutations that right now we have data that predict relapse and the outcome in NPM1, but FLT3, the two-stage MRD of FLT3 by PCR, and then next-generation sequencing is coming in. And in the last year, there was discussion about whether IDH1 or IDH2 is good for MRD monitoring, and IDH2 maybe yes. And the same we have with the KMT2A. So MRD and mutation dictate today the result of transplantation and we are referring patients to transplant according to disease. So the big issue is if a patient is MRD negative pre-transplant and at high risk, should we, you know, maybe omit transplantation or, you know, defer transplant. And this is, in most of the cases, our open question, but there is more and more data that in some categories, you know, if the patient is MRD negative and especially sustained MRD negative, we may not need transplantation.
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