OnCo
ideasIdea

MRD-guided transplant decisions in intermediate-risk AML

Use ultra-sensitive residual-disease tests after induction to decide who really needs a transplant, sparing the rest its risks.

ELN 2022 already recommends transplant for intermediate-risk AML with MRD positivity; randomised confirmation is lacking. myeloMATCH and European trials (e.g., HOVON, AMLSG) are stratifying consolidation by molecular MRD.

Hypothesis
Intermediate-risk AML patients who are MRD-negative by NPM1 qPCR or error-corrected NGS after two cycles can safely receive chemotherapy consolidation instead of allogeneic transplant, with equal OS and less toxicity.
Rationale
MRD status is the strongest predictor of relapse; transplant carries 10-20% mortality; retrospective data show transplant benefit concentrates in MRD-positive patients.
What would test it
Randomised MRD-negative intermediate-risk patients to transplant vs consolidation with MRD surveillance and pre-emptive therapy at molecular relapse; primary endpoint OS.
Maturity
being tested at scale

Connected

6top

Pages like this

not linked directly; found by shared links

cancers

1
Acute myeloid leukaemia

technologies

2
Allogeneic stem cell transplantationNGS-based MRD (clonoSEQ and molecular MRD)

terms

2
ELN 2022 risk classificationMRD-negative complete remission

trials

1
myeloMATCH