Measurable Residual IDH1 before Allogeneic Transplant for Acute Myeloid Leukemia

Measurable residual disease (MRD) in adults with acute myeloid leukemia (AML) in complete remission is an important prognostic marker, but detection methodology requires optimization. The persistence of mutated or -ITD in the blood of adult patients with AML in first complete remission (CR1) prior to allogeneic hematopoetic cell transplant (alloHCT) has been established as associated with increased relapse and death after transplant. The prognostic implications of persistence of other common AML-associated mutations, such as , at this treatment landmark however remains incompletely defined. We performed testing for residual variants ( m) in pre-transplant CR1 blood of 148 adult patients undergoing alloHCT for -mutated AML at a CIBMTR site between 2013-2019. No post-transplant differences were observed between those testing m positive (n=53, 36%) and negative pre-transplant (overall survival: p = 0.4; relapse: p = 0.5). For patients with mutated AML co-mutated with and/or -ITD, only detection of persistent mutated and/or -ITD was associated with significantly higher rates of relapse (p = 0.01). These data, from the largest study to date, do not support the detection of mutation in CR1 blood prior to alloHCT as evidence of AML MRD or increased post-transplant relapse risk.