Incorporating measurable ('minimal') residual disease-directed treatment strategies to optimize outcomes in adults with acute myeloid leukemia.
Curative-intent therapy leads to complete remissions in many adults with acute myeloid leukemia (AML), but relapse remains common. Numerous studies have unequivocally demonstrated that the persistence of measurable ('minimal') residual disease (MRD) at the submicroscopic level during morphologic remission identifies patients at high risk of disease recurrence and short survival. This association has provided the impetus to customize anti-leukemia therapy based on MRD data, a strategy that is now routinely pursued in acute promyelocytic leukemia (APL). While it is currently uncertain whether this approach will improve outcomes in AML other than APL, randomized studies have validated MRD-based risk-stratified treatment algorithms in acute lymphoblastic leukemia. Here, we review the available studies examining MRD-directed therapy in AML, appraise their strengths and limitations, and discuss avenues for future investigation.
a Section of Hematology/Oncology and University of Chicago Comprehensive Cancer Center , University of Chicago , Chicago , IL , USA ;
Kristen
K
Pettit
a Section of Hematology/Oncology and University of Chicago Comprehensive Cancer Center , University of Chicago , Chicago , IL , USA ;
Wendy
W
Stock
b Clinical Research Division , Fred Hutchinson Cancer Research Center , Seattle , WA , USA ;|c Department of Medicine, Division of Hematology , University of Washington , Seattle , WA , USA ;|d Department of Epidemiology , University of Washington , Seattle , WA , USA.
Roland B
RB
Walter
D002986:Clinical Trials as Topic; D003131:Combined Modality Therapy / Q000009:adverse effects / Q000379:methods; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D018365:Neoplasm, Residual / Q000473:pathology*; D016896:Treatment Outcome
Acute myeloid leukemia (AML); adult; measurable residual disease (MRD); prognosis; risk-directed therapy