EHA 2021 | The role of pre-transplant MRD assessment in patients with AML
Arnon Nagler, MD, Chaim Sheba Medical Center, Tel-Aviv, Israel, discsses the role of measurable residual disease (MRD) as a key indicator of disease prognosis and disease outcomes in patients with acute myeloid leukemia (AML). Prof. Nagler highlights the role of MRD in treatment with novel therapies, including IDH inhibitors and FLT3 inhibitors, as well as in the field of transplantation. In transplantation, Prof. Nagler reports that patients who undergo allogeneic transplantation and receive post-transplant cyclophoshamide as graft-versus-host disease (GvHD) prophylaxis and achieve MRD-negativity have a lower relapse rate, improved overall survival, and improved GvHD-free survival. This interview took place at the virtual European Hematology Association (EHA) Congress 2021.
Transcript (edited for clarity)
MRD or measurable residual disease, once called minimal residual disease, is becoming a very important prognostic factor for treating AML, and also for transplantation. There were a few talks this year about the role of MRD for treatment of leukemia, not just with chemotherapy, but with the new agents. So, they will talk about combination with IDH inhibitors and venetoclax, and with other venetoclax and Vidaza, or venetoclax with gilteritinib...
MRD or measurable residual disease, once called minimal residual disease, is becoming a very important prognostic factor for treating AML, and also for transplantation. There were a few talks this year about the role of MRD for treatment of leukemia, not just with chemotherapy, but with the new agents. So, they will talk about combination with IDH inhibitors and venetoclax, and with other venetoclax and Vidaza, or venetoclax with gilteritinib.
In all of these studies it was shown that the MRD is important factor, this was non-transplant studies, MRD is very important factors. In patient with MRD negativity their overall survival in leukemia-free survival is much better than the one with MRD positivity, because of lower relapse rate. But this was also shown by us and by other, in allogeneic transplantation. We even did a survey in the EBMT centers, across all 600 centers, to see how they do MRD from when, to whom, in what methods, because there are several methods.
There was no data about the role of MRD with transplantation with post-transplant cyclo. So, post-transplant cyclo is a new mode of anti-GVHD prophylaxis in transplant, have been showing to reduce the transplant-related mortality and the chronic GVHD. It started with haploidentical transplant. They then moved to unrelated and sibling transplantation.
So, we now show in the setting of unrelated transplantation that the patients that receive post-transplant cyclo, again, MRD is important factor, because in patients that are MRD-negative pre-transplantation, there is a lower relapse rate and improved transplantation outcome, and overall survival, leukemia-free survival and GVHD relapse-free survival.
So, MRD is very important factor, prognostic factor, also with post-transplant cyclo, and this is important because the biology of the transplantation with post-transplant cyclo is different because the post-transplant cyclo upregulates the regulatory cells, it use a kind of tolerance and abrogates the NK activity on the donor in the first months post-transplant. Therefore, there was a question if this will change the graft-versus-leukemia effect, and the relapse rate, and the importance prognostic factor of MRD, and again, we show that as in other GVHD prophylaxis, the conventional ways, the MRD is also prognostic factor, with allogeneic transplantation for AML is post-transplant cyclophosphamide.
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