Prognostic impact of MRD in AML patients undergoing allo-HCT with Flu/Treo10 conditioning
Pyka J, Metzdorf J, Reicherts C, et al. Treosulfan-Based Conditioning Ameliorates Impact of Pretransplant MRD-Positivity in AML Patients Allografted in Remission. Transplantation and Cellular Therapy. 2025; (doi: 10.1016/j.jtct.2025.10.011).
Reduced-intensity conditioning with treosulfan and fludarabine before allogeneic hematopoietic cell transplantation (allo-HCT) is safe and effective, a real-world analysis affirms. Researchers retrospectively examined 102 transplant recipients at a single facility who underwent conditioning with treosulfan 3 x 10g/m2 plus fludarabine (FluTreo10) prior to their first HCT for acute myeloid leukemia (AML). All of the participants were in first or second complete remission before the procedure, with known measurable residual disease (MRD) status. At 3-year follow-up, investigators documented survival, relapse-free survival, cumulative incidence of relapse, and non-relapse mortality at 68%, 53%, 38%, and 8%, respectively. The results tracked closely with a pivotal Phase III randomized controlled trial (RCT) that identified FluTreo10 as an accepted regimen in allo-HCT for older AML patients or those with myelodysplastic syndromes. Unlike the RCT, the real-world analysis also looked at the prognostic impact of MRD, concluding that positive MRD status in the pretransplant period did not correlate to poor outcomes post-procedure. Factors that did influence outcomes include secondary AML, complex karyotype, and other baseline disease markers, the study authors report.