Prognostic Impacts of D816V Mutation and Peri-Transplant MRD Monitoring on Acute Myeloid Leukemia with .

The prognostic significance of mutations and optimal thresholds and time points of measurable residual disease (MRD) monitoring for acute myeloid leukemia (AML) with remain controversial in the setting of hematopoietic stem cell transplantation (HSCT). We retrospectively evaluated 166 high-risk patients who underwent allogeneic (Allo-HSCT, = 112) or autologous HSCT (Auto-HSCT, = 54). D816V mutation, a subtype of exon 17 mutations, was significantly associated with post-transplant relapse and poor survival, while other types of mutations in exons 17 and 8 were not associated with post-transplant relapse. Pre- and post-transplant MRD assessments were useful for predicting post-transplant relapse and poor survival with a higher sensitivity at later time points. Survival analysis for each stratified group by D816V mutation and pre-transplant MRD status demonstrated that Auto-HSCT was superior to Allo-HSCT in MRD-negative patients without D816V mutation, while Allo-HSCT was superior to Auto-HSCT in MRD-negative patients with D816V mutation. Very poor outcomes of pre-transplant MRD-positive patients with D816V mutation suggested that this group should be treated in clinical trials. Risk stratification by both D816V mutation and MRD status will provide a platform for decision-making or risk-adapted therapeutic approaches.