Acute Myeloid Leukemia-Use of Measurable Residual Disease to Improve Outcomes.

Measurable residual disease (MRD) assessment following initial therapy attempts to detect low levels of leukemia cells that remain undetectable by conventional cytomorphological methods. MRD-negativity after induction therapy in patients with acute myeloid leukemia (AML) is strongly associated with improved disease-free and overall survival, making results of MRD testing a more reliable indicator of treatment response compared to traditional methods. Unfortunately, due in part to genetic and phenotypical heterogeneity, no perfect MRD assay for AML currently exists although multiple tests are currently in use. Understanding the performance characteristics of AML MRD tests is critical for their clinical use. After achieving first complete remission with chemotherapy, consolidation therapy aims to deepen remission and prolong response duration. For patients with difficult-to-treat AML, allogeneic stem cell transplantation (allo-SCT) is a key strategy for achieving durable remission. However, for patients with a relatively favorable risk profile, the benefits of allo-SCT may not outweigh its risks, and durable remission can often be achieved with chemotherapy alone. When the benefits of allo-SCT are less clear, MRD can refine patient selection. MRD assessment after induction chemotherapy using validated methods can signal the need for more aggressive or alternative treatments to mitigate relapse risk. MRD-negative patients eligible for transplantation might benefit from reduced treatment intensity or modified conditioning to avoid overtreatment. Additionally, MRD can guide the intensity of conditioning therapy in transplant-eligible patients. Post-transplant MRD monitoring can further identify patients who may benefit from preemptive treatments to maintain remission. Integrating MRD into treatment protocols allows clinicians to enhance therapeutic precision, optimize patient outcomes, and improve the likelihood of achieving long-term remission in AML. However, due to limitations associated with current AML MRD testing, careful consideration and validation are essential before incorporating MRD findings into routine clinical practice.