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A potential predictor of post-transplant relapse — testing the limits of measurable residual disease detection

For patients with acute myeloid leukemia (AML) pursuing blood or marrow transplant, efforts are made to rid their bodies of cancer — reaching complete remission — before they embark on the transplant. This study looks at using a new highly sensitive DNA testing technique to look for measurable residual disease (MRD), or very small amounts of cancer cells that may be left after treatment. Having measurable residual disease is associated with higher risk for the cancer to come back (relapse) and decreased overall survival after transplant. But how much MRD needs to be present to constitute higher risk? Is every patient with measurable residual disease at equal risk?

To answer those questions and more, the Center for International Blood and Marrow Transplant Research (CIBMTR) in collaboration with National Heart Lung and Blood Institute (NHLBI) conducted a study using patient blood samples from before transplant. These researchers used a highly sensitive DNA testing technique called next-generation sequencing to search for answers. The testing approach is 100 times more sensitive than previous measurement techniques.

Researchers determined that 129 of 448 patients in clinical complete remission had measurable residual disease prior to transplant. That measurable residual disease would not have been detected by the testing methods currently used by most centers.

In this study, 36% of patients who had measurable residual disease present before transplant were alive without the cancer coming back three years after transplant. This is compared to 56% for patients who didn’t have measurable residual disease before transplant.

Being able to detect measurable residual disease using next-generation sequencing could be an important tool for identifying patients at greater risk of relapse after transplant. For those who have measurable residual disease, physicians may be able to adjust the treatment approach to improve outcomes.

More research is necessary to confirm the findings and determine what steps to take when measurable residual disease is found before transplant. The approach also could be used to monitor patients for early relapse after transplant. This could allow physicians the chance to intervene with treatment earlier.

The CIBMTR is launching a study called MEASURE to develop measurable residual disease testing as a standard for pre-transplant evaluation and post-transplant monitoring.

Measurable residual disease testing may be able to help patients and providers use a more advanced approach to identify the best timing for transplant and additional treatment.

Learn more by reviewing a comprehensive analysis and description of the study.

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