Bhavana “Tina” Bhatnagar, DO, discusses the investigation of minimal residual disease negativity in patients with acute myeloid leukemia.
Bhavana “Tina” Bhatnagar, DO, assistant professor, Department of Medicine, West Virginia University; associate professor, Section of Hematology/Oncology, director, Hematology and Medical Oncology, West Virginia University Cancer Institute, discusses the investigation of minimal residual disease (MRD) negativity in patients with acute myeloid leukemia (AML).
Although the role of MRD negativity is well defined in acute lymphoblastic leukemia, where small amounts of residual disease can predict for worse survival outcomes, in AML, the role of MRD negativity is less clear, Bhatnagar says. In AML, MRD negativity is associated with improved survival outcomes, Bhatnagar explains. However, questions remain regarding the definition of MRD negativity in this disease, as well as what assays should be used and what the sensitivity of those assays should be, Bhatnagar emphasizes.
MRD negativity by flow cytometry or next-generation sequencing that shows no recurrence of the mutations patients had at diagnosis is predictive of improved post-transplant responses, according to Bhatnagar. The goal of AML treatments is to achieve as much disease control as possible to improve patient outcomes, Bhatnagar notes.
Although trials investigating uproleselan (GMI-1271) in patients with AML have used multiparameter flow cytometry to detect MRD, the accuracy of this assessment depends on the sensitivity of the assay and its ability to detect small amounts of leukemic cells, Bhatnagar says. AML remains difficult to cure because AML cells are proliferative, and their locations can vary, Bhatnagar explains.
Clinical trials that use MRD negativity as an end point can inform patients with AML who are interested in learning about the benefits of MRD negativity and knowing the MRD levels that predict relapse and survival, Bhatnagar emphasizes. MRD negativity is a reasonable end point to use when translating clinical trial findings into meaningful information for patients, Bhatnagar concludes.