MRD assessment to guide pre-emptive treatment decisions

The phase 2 RELAZA2 trial evaluated the role of hypomethylation agent azacitidine in minimal residual disease (MRD)-guided pre-emptive therapy to prevent or delay relapse in patients with myelodysplastic syndromes (MDS) or acute myeloid leukaemia (AML) after chemotherapy and allogenic stem cell transplantation. The authors concluded that MRD monitoring can identify patients who are likely to relapse, and MRD-guided maintenance with azacitidine could be an effective strategy to delay relapse.

Prof. Uwe Platzbecker (University Hospital Carl Gustav Carus, Germany) presented the prospective study, which aimed to determine whether MRD-guided pre-emptive treatment with azacitidine could prevent relapse [1]. The researchers screened 198 patients with advanced MDS (n=26) or AML (n=172). Of these patients, 30% tested positive for MRD during the 24-month screening period.

A total of 53 patients (88%) were eligible to start study treatment with azacitidine. After 6 months of treatment, 31 out of 53 patients were relapse-free (58%; 95% CI 44-72; P<0.0001). With a median follow-up of 13 months after the start of MRD-guided treatment, relapse-free survival at 12 months was 46% (95% CI 32-59) in the 53 patients who were MRD-positive and received azacitidine. In MRD-negative patients, 12-month relapse-free survival was 88% (HR 6.6; 95% CI 82-84; P<0.0001).

The most common (grade 3-4) adverse event was neutropenia, occurring in 45 (85%) of 53 patients. One patient with neutropenia died because of an infection, which was possibly related to study treatment.

In conclusion, this study demonstrated that MRD monitoring can reliably identify patients who are likely to relapse. Timely intervention with azacitidine could be an effective strategy to delay relapse. These data support the prognostic importance of MRD monitoring in AML and MDS.

1. Platzbecker U, et al. Abstract 644, ASH 2019, 7-10 December, Orlando, USA.

Posted on 5 March, 202016 February, 2024