{"entity":{"id":"idea-mrd-guided-transplant-aml","kind":"idea","name":"MRD-guided transplant decisions in intermediate-risk AML","aka":[],"tldr":"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.","asOf":"2026-09-07","links":[{"label":"ClinicalTrials.gov NCT05564390: myeloMATCH","url":"https://clinicaltrials.gov/study/NCT05564390"}],"tags":[],"related":[],"cancers":["aml"],"sections":[],"technologies":["ngs-mrd-clonoseq","allogeneic-hsct"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":["mrd-negative-cr","eln-risk"],"trials":["myelomatch"],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"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.","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"},"route":"/ideas/idea-mrd-guided-transplant-aml/","neighbours":{"cancer":[{"id":"aml","kind":"cancer","name":"Acute myeloid leukaemia","route":"/cancers/aml/"}],"technology":[{"id":"allogeneic-hsct","kind":"technology","name":"Allogeneic stem cell transplantation","route":"/technologies/allogeneic-hsct/"},{"id":"ngs-mrd-clonoseq","kind":"technology","name":"NGS-based MRD (clonoSEQ and molecular MRD)","route":"/technologies/ngs-mrd-clonoseq/"}],"term":[{"id":"eln-risk","kind":"term","name":"ELN 2022 risk classification","route":"/terms/eln-risk/"},{"id":"mrd-negative-cr","kind":"term","name":"MRD-negative complete remission","route":"/terms/mrd-negative-cr/"}],"trial":[{"id":"myelomatch","kind":"trial","name":"myeloMATCH","route":"/trials/myelomatch/"}]}}