Key clinical point: Clinical therapeutic decisions based on dynamic measurable residual disease (MRD) may improve therapy stratification and optimize post-remission treatment with either chemotherapy, autologous stem cell transplant (auto-SCT), or allogeneic SCT (allo-SCT) in patients with intermediate-risk acute myeloid leukemia (AML).
Major finding: In patients with persistent MRD-negative after 1, 2, or 3 chemotherapy cycles, chemotherapy ( P = .03) and auto-SCT ( P = .01) vs allo-SCT improved graft-vs-host-disease-free, relapse-free survival. Allo-SCT led to favorable outcomes among patients with persistent MRD-positive or MRD-negative after 3 chemotherapy courses and those with recurrent MRD-positive after MRD-negative. Patients who were MRD-negative after 2 chemotherapy cycles had better leukemia-free survival, overall survival, and relapse with auto-SCT vs allo-SCT and chemotherapy (all P less than .05).
Study details: Findings are from 549 patients with intermediate-risk AML treated with either chemotherapy, auto-SCT or allo-SCT after the first complete remission.
Disclosures: This study was funded by grants from the National Key Research and Development Projects, National Natural Science Foundation of China, and others. The authors declared no conflicts of interest.
Source: Yu S et al. JAMA Netw Open. 2021 Jul 7. doi: 10.1001/jamanetworkopen.2021.15991 .