Testing for measurable residual disease (MRD) prior to bone marrow transplant may be effective and practical in patients in remission after receiving treatment for acute myeloid leukemia (AML), according to a recent study published by Dillon et al in JAMA Oncology.
Study Methods and Results
In the recent study, the researchers used targeted ultra-deep DNA sequencing to search for FLT3 gene mutations in the blood of 537 patients with AML in remission and awaiting bone marrow transplants.
The researchers found that if as little as 1 in 10,000 molecules of DNA tested positive for a mutation, it corresponded with a higher risk of cancer recurrence and a lower rate of survival with current standard treatments.
Conclusions
“Genetic testing is just one tool. It's not the total answer but it can help us personalize our therapy more—so long as the guide rails are in place for safety—as we understand better how beneficial prior treatments have been to the individual patient. We don't want to treat a number. We’re treating the person. But if it helps that person, then, yes, we should use the number,” emphasized senior study author Christopher Hourigan, DM, DPhil, Professor of Internal Medicine at the Carilion School of Medicine and Director of the Cancer Research Center at the Fralin Biomedical Research Institute at Virginia Tech.
“The good news is this testing is doable. We had previously shown this genetic approach massively outperformed the current testing being done clinically. This work goes further and shows [we] don't need to be at a specialized center with customized technology and high levels of expertise—testing can be done using commercially available kits potentially at any major modern hospital lab. It is now a matter of implementation,” he concluded.
Disclosure: The research in this study was supported by the Intramural Research Program of the National Heart, Lung, and Blood Institute. For full disclosures of the study authors, visit jamanetwork.com.
