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ESH AL 2026 | Evaluating the use of MRD status to guide post-remission therapy in AML
Richard Stone, MD, Dana-Farber Cancer Institute, Boston, MA, comments on the use of measurable residual disease (MRD) results to guide therapy in certain subgroups of patients with acute myeloid leukemia (AML). He highlights that MRD negativity after two cycles of chemotherapy can inform the decision to forgo allogeneic stem cell transplant and consolidation in patients with NPM1-mutated disease, and notes emerging data on the use of MRD in FLT3-mutated disease. This interview took place at the 5th How to Diagnose and Treat: Acute Leukemias meeting of the European School of Hematology (ESH AL) in Mandelieu-La Napoule, France.
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Transcript
Well, that is a difficult question and could probably take quite a while to answer. The short version is that many doctors and academic centers, at least for certain subgroups, use MRD results to guide therapy. Probably the best example is in NPM1 mutant patients who, if they achieve MRD negativity after two cycles of chemotherapy, generally you’re thought not to require allogeneic stem cell transplant and consolidation, whereas the ones who are MRD positive might benefit from allogeneic stem cell transplant...
Well, that is a difficult question and could probably take quite a while to answer. The short version is that many doctors and academic centers, at least for certain subgroups, use MRD results to guide therapy. Probably the best example is in NPM1 mutant patients who, if they achieve MRD negativity after two cycles of chemotherapy, generally you’re thought not to require allogeneic stem cell transplant and consolidation, whereas the ones who are MRD positive might benefit from allogeneic stem cell transplant. I think that’s the most clear-cut use and maybe the most common use of MRD to guide post-remission therapy. There’s emerging data with a super-sensitive FLT3 assay that might guide the, if positive, before or after stem cell transplant, that might guide the use of gilteritinib in the post-transplant setting for FLT3 mutant patients. Otherwise, it’s a bit less clear-cut, although many studies are being done to try to evaluate the utility and potential surrogacy of MRD positivity to predict overall outcome for patients.
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