Minimal residual disease

Individualized insights to monitor disease progression

For patients diagnosed with acute myeloid leukemia (AML), which is the second most common type of leukemia, monitoring for measurable, or minimal residual disease (MRD), is a critical component of establishing prognosis and predicting therapeutic response. MRD testing performed at diagnosis as well as after treatment, which can include hematopoietic stem cell transplant, provides physicians key information to:

• Refine outcome prediction and inform choice of post-remission therapy.
• Identify impending relapse.
• Monitor post-hematopoietic stem cell transplant remission status.
• Objectively assess a deeper remission status beyond the recommended 5% morphology cutoff.

Cytogenic findings typically revealed through diagnostic testing are most often used to understand disease prognosis. Among patients with genetic alterations, those with an NPM1 mutation in the absence of FLT3-ITD are associated with more favorable prognoses. Identification of NPM1 can help evaluate MRD and therapeutic response following treatment.

When to consider testing
For AML patients identified as having an NPM1 mutation, MRD testing is recommended² at:

• Time of diagnosis.
• During morphologic remission with full or partial hematologic recovery.
  • Following two cycles of chemotherapy (peripheral blood {PB}).*
  • At the end of consolidation (bone marrow {BM}).
  • After the end of consolidation, in PB or BM for 24 months. BM every 3 months or PB every 4-6 weeks.
    • *Either 2 induction cycles or 1 induction and 1 consolidation cycle; includes the time point before allogenic hematopoietic cell transplantation (allo-HCT).