# MRD-guided transplant decisions in intermediate-risk AML

Source: https://onco.cc/ideas/idea-mrd-guided-transplant-aml/  
OnCo record `idea-mrd-guided-transplant-aml` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Use ultra-sensitive residual-disease tests after induction to decide who really needs a transplant, sparing the rest its risks.

## Summary

The idea is to use ultra-sensitive residual disease tests, NPM1 qPCR or error-corrected NGS, after two cycles of induction to decide which intermediate-risk acute myeloid leukaemia patients really need an allogeneic transplant. MRD status is the strongest predictor of relapse, transplant carries substantial risk, and its benefit concentrates in MRD-positive patients; ELN 2022 already recommends transplant for them, but randomised confirmation is lacking. The hypothesis is that MRD-negative patients can receive chemotherapy consolidation instead with equal overall survival and less toxicity. The test randomises MRD-negative patients to transplant or consolidation with MRD surveillance; myeloMATCH, HOVON and AMLSG trials already stratify by MRD, so it is being tested at scale.

## Fields

- Kind: Idea
- Last checked: 2026-09-07
- Hypothesis: Intermediate-risk AML patients who are MRD-negative by NPM1 qPCR or error-corrected NGS after two cycles can safely receive chemotherapy consolidation instead of allogeneic transplant, with equal OS and less toxicity.
- Rationale: MRD status is the strongest predictor of relapse; transplant carries 10-20% mortality; retrospective data show transplant benefit concentrates in MRD-positive patients.
- Proposed test: Randomised MRD-negative intermediate-risk patients to transplant vs consolidation with MRD surveillance and pre-emptive therapy at molecular relapse; primary endpoint OS.
- Maturity: being-tested-at-scale

## Sources

- ClinicalTrials.gov NCT05564390: myeloMATCH: https://clinicaltrials.gov/study/NCT05564390

## Connected records

- cancers: [Acute myeloid leukaemia](https://onco.cc/cancers/aml/)
- technologies: [Allogeneic stem cell transplantation](https://onco.cc/technologies/allogeneic-hsct/), [NGS-based MRD (clonoSEQ and molecular MRD)](https://onco.cc/technologies/ngs-mrd-clonoseq/)
- terms: [ELN 2022 risk classification](https://onco.cc/terms/eln-risk/), [MRD-negative complete remission](https://onco.cc/terms/mrd-negative-cr/)
- trials: [myeloMATCH](https://onco.cc/trials/myelomatch/)

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