Peripheral blood molecular measurable residual disease is sufficient to identify patients with acute myeloid leukaemia with imminent clinical relapse

• Published in: British journal of haematology 2021-11, Vol.195 (3), p.310-327
• Main Authors: Skou, Anne‐Sofie, Juul‐Dam, Kristian Løvvik, Ommen, Hans B., Hasle, Henrik
• Format: Article
• Language: English
• Subjects: acute myeloid leukaemia; Acute myeloid leukemia; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biomarkers, Tumor - blood; Bone marrow; Bone Marrow - pathology; Early Diagnosis; Hematology; Humans; Leukemia; Leukemia, Myeloid, Acute - blood; Leukemia, Myeloid, Acute - drug therapy; Leukemia, Myeloid, Acute - pathology; measurable residual disease; molecular relapse; Neoplasm, Residual; Neoplastic Cells, Circulating; Nucleophosmin - genetics; Oncogene Proteins, Fusion - genetics; Patients; Peripheral blood; Polymerase chain reaction; Predictive Value of Tests; pre‐emptive therapy; quantitative polymerase chain reaction; Real-Time Polymerase Chain Reaction - methods; Recurrence; Remission; Remission (Medicine); Remission Induction; RNA, Long Noncoding - genetics; RNA, Messenger - blood; RNA, Neoplasm - blood; Sensitivity and Specificity
• ISSN: 0007-1048; 1365-2141
• DOI: 10.1111/bjh.17449

Summary Longitudinal molecular measurable residual disease (MRD) sampling after completion of therapy serves as a refined tool for identification of imminent relapse of acute myeloid leukaemia (AML) among patients in long‐term haematological complete remission. Tracking of increasing quantitative polymerase chain reaction MRD before cytomorphological reappearance of blasts may instigate individual management decisions and has paved the way for development of pre‐emptive treatment strategies to substantially delay or perhaps even revert leukaemic regrowth. Traditionally, MRD monitoring is performed using repeated bone marrow aspirations, albeit the current European LeukemiaNet MRD recommendations acknowledge the use of peripheral blood as an alternative source for MRD assessment. Persistent MRD positivity in the bone marrow despite continuous morphological remission is frequent in both core binding factor leukaemias and nucleophosmin 1‐mutated AML. In contrast, monthly assessment of MRD in peripheral blood superiorly separates patients with imminent haematological relapse from long‐term remitters and may allow pre‐emptive therapy of AML relapse.