Using minimal (measurable) residual disease assessments to guide decision-making for timing of allogeneic transplantation in acute myeloid leukemia.

Abstract

The current review aims to highlight recent and important developments in the detection and value of minimal (measurable) residual disease (MRD) testing in patients with acute myeloid leukemia (AML) and the impact on the timing of allogeneic hematopoietic cell transplantation. The European LeukemiaNet MRD Working Party recently published guidelines to help standardize testing, utilizing flow cytometry and molecular techniques. The timing of MRD assessments, choice of assay and cutoff of for reporting positive results are all important. Patients known to be MRD-positive pretransplantation have a poor prognosis and consideration should be given to selecting a myeloablative regimen over a reduced intensity regimen (if appropriate) and offering posttransplantation maintenance therapy. It may be best to think of MRD as a dynamic variable, where a rising MRD result is more specific and highly predictive of relapse. It is unclear how MRD results should impact the timing of allogeneic hematopoietic cell transplantation, if at all. There are currently no published randomized studies to help guide the practitioner in this situation, hence decision-making should be individualized.