Blood cancers

MRD associated with significantly better long-term survival in AML

Negative measurable residual disease (MRD) is associated with significantly better long-term survival in acute myeloid leukaemia (AML), a large meta-analysis has shown.

Calculations using data from 81 studies showed a 64% reduction in the risk of death for MRD-negative patients.

The findings were consistent across a range of approaches for measuring MRD except for the use of cytogenetics/fluorescent in situ hybridisation. The association was also consistent across age, disease subtype and time of assessment, the researchers reported in JAMA Oncology.

It suggests that MRD status has prognostic importance in AML, the international team of researchers concluded, pointing out that the “magnitude of benefit was substantial”.

In addition, it suggests the use of MRD should be considered as an end point in clinical trials to speed up the development of new drugs, they said.

A total of 11,151 patients were included in the analysis which found the estimated 5-year disease-free survival was 64% for patients without MRD and 25% for those with MRD.

The estimated overall survival was 68% for patients without MRD and 34% for those with MRD

“These data have several potential implications for both clinical practice and drug development in AML,” the researchers concluded.

“In addition to supporting the use of MRD testing to provide prognostic information, the poor outcomes associated with the presence of MRD support the development of novel therapeutic approaches for these patients.”

They added: “Given the robustness of the association of MRD with long-term outcomes across studies, use of MRD status as an eligibility criterion and/or an end point in clinical trial design could lead to more efficient assessment of the efficacy of new drugs and combination therapies in AML.”

In an accompanying editorial, a team from Chao Comprehensive Cancer Center at the University of California-Irvine agreed that using MRD negativity as a surrogate end point in AML clinical trials may speed up trials for newer more effective treatments.

“Given that the standard of care therapy for AML of ‘3+7’ has not changed in over 40 years and yet cures only a minority of adults with AML, more rapid drug development of therapies for AML is needed,” they said.

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