Among patients with acute leukemia, positive pre-allogeneic hematopoietic stem cell transplantation (allo-HSCT) minimal residual disease (MRD) status is linked with worse survival and disease prognosis after transplant, according to research published in Hematology.
Acute leukemia, which represents a varied set of hematologic cancers, has a wide range of morphological and molecular characteristics, necessitating a targeted approach to disease management. While allo-HSCT has greatly improved prognosis and survival outcomes, post-transplant relapse remains a significant problem and is linked with worse overall survival outcomes.
MRD-negativity, where traces of leukemia cells are not detected among patients in complete remission, is a known predictor of relapse, and is used widely to stratify patients and inform treatment decision-making. For this study, researchers retrospectively analyzed patient data to determine any link between MRD status prior to allo-HSCT and outcomes among patients with acute leukemia.
Overall, data from 114 patients were included. Of these, 32 patients had MRD-positive status, while 82 were MRD-negative. In the MRD-positive and -negative groups, 11 (34.4%) and 42 (51.2%) were male, respectively, 8 (25%) and 35 (42.7%) had acute lymphoblastic leukemia, 24 (75%) and 47 (57.3%) had acute myeloid leukemia, and 25 (78.1%) and 72 (87.8%) were at first complete remission.
Acute graft-vs-host-disease incidence was not significantly different in the MRD-positive and -negative groups (P =.09), although patients with MRD-negative status had a higher rate of chronic graft-vs-host-disease (P =.008). No difference in relapse rates between the 2 groups was noted.
Patients with MRD-positive status had both worse 1-year overall survival (P =.003) and 1-year progression-free survival (P =.009) rates. MRD-positive status was an independent prognostic factor for overall survival on multivariate analysis (hazard ratio: 1.898; P =.036).
“All of these studies suggested that MRD is indeed an important factor in relapse and survival, the higher level of MRD, might be a sign of worse prognosis,” the authors wrote.
Shen X, Pan J, Qi C, et al. Impact of pre-transplantation minimal residual disease (MRD) on the outcome of allogeneic hematopoietic stem cell transplantation for acute leukemia. Hematology. 2021;26(1):295-300. doi:10.1080/16078454.2021.1889162