Benefits of Utilizing MRD Negativity to Determine Transplant Eligibility for Patients With AML
At the 2025 Great Debates (GD) in Hematologic Malignancies meeting in New York, New York, Andrew Artz, MD, MS, City of Hope, Duarte, California, participated in a debate on minimal residual disease (MRD) negativity as the primary marker for transplantation eligibility among patients with acute myeloid leukemia (AML), highlighting the benefits of MRD negativity as a decision-making tool, including the ability to tailor treatments for patients.
Transcript:
Hello, my name is Andrew Artz. I am a professor in the division of leukemia in the Department of Hematology at the City of Hope in Duarte, California.
Today I'm discussing my side of a debate, which is, yes, we should use MRD in AML as the predominant tool for decision making when considering transplant. I want to bring up a few key points from our debate that are, perhaps the essential elements to distill from it.
The first is we both acknowledge, Dr. Daver and I, that MRD testing is not a monolithic tool. There are a set of different tools that are needed to be used and that's really essential when monitoring patients with AML. The key point to me is that the tools are improving over time. Looking ahead in the future, increasingly MRD will be the predominant way we understand risk stratification for AML in remission and when to use transplant as well as how to use transplant.
Right now, it's best shown for patients with NPM1-positive AML or FLT3-ITD AML. First of all, MRD positivity after induction leads to poor outcomes and transplant outcomes appear to be better, especially for NPM1-positive MRD versus non-transplant. We certainly know that at the time of transplant, MRD is quite prognostic and patients who are MRD in general, especially with our better assays and for genes that we can better evaluate by MRD patients do worse.
Some key aspects of that are the MRD can be used to tailor our transplant platforms. I'll give 2 key examples. In FLT3-ITD-mutated AML from the MORPHO-1506 study, patients who were MRD-positive benefited from maintenance therapy with gilteritinib. There are additional data that show that intensifying conditioning regimens in transplant appears to benefit patients who are MRD that is higher intensity mitigates some of the relapse risk associated with MRD.
In conclusion, to me, although MRD may not be the only tool that we use to evaluate whether or not someone proceeds to transplant, I think it's perhaps the most important tool for patients with AML in remission, not only to decide on whether to do a transplant, but how we do a transplant, how patients will fare with and without a transplant. That allows us to have a more holistic recommendation for our patients about not just whether to pursue a transplant, but how to pursue the transplant. Thank you.
Source:
Artz A. Debate- Should the Recommendation for HSCT in the Treatment of Acute Myeloid Leukemia be Determined Predominantly by MRD? Yes or No. Presented at the Great Debates in Hematologic Malignancies meeting. June 28-29, New York, New York.
