Monitoring Patients Being Treated for AML

This is a synopsis of an Insights series featuring Catherine E. Lai, MD, MPH, of the University of Pennsylvania.

Dr. Catherine E. Lai explained that the goal of first-line AML treatment is to achieve complete remission, defined as bone marrow blasts <5% with blood count recovery (ANC >1000, platelets >100,000). However, complete remission does not equal cure, so post-remission treatment focuses on consolidative chemotherapy or proceeding to bone marrow transplant, the only potential cure.

She emphasized the importance of bone marrow biopsies after cycle 1 of treatment, irrespective of whether the patient received intensive induction like 7+3 or hypomethylating therapy like azacitidine/venetoclax. For 7+3, the day 14-21 biopsy shows treatment response when counts are low. After count recovery, a biopsy confirms complete remission status. For azacitidine/venetoclax, a biopsy around day 21-28 of cycle 1 guides decisions about holding venetoclax until count recovery before subsequent cycles, which can prevent complications.

Regarding minimal residual disease (MRD) testing, Dr. Lai noted this is best done at count recovery, not in hypocellular marrows. MRD status prior to transplant is critical, with data showing worse outcomes and higher relapse risk when patients are MRD-positive pre-transplant. Thus, MRD negativity by flow cytometry or molecular testing is ideal pre-transplant. However, standardization of MRD testing remains a challenge given AML heterogeneity, with no one-size-fits-all approach.

In summary, bone marrow assessment during and after initial chemotherapy is critical to evaluate response and guide subsequent treatment decisions in working toward the goals of complete remission and MRD negativity, especially for patients proceeding to transplant. Dr. Lai provided insights into optimal biopsy timing and the evolving role of MRD testing in AML management.

*Video synopsis is AI-generated and reviewed by OncLive editorial staff.