Molecular residual disease.

Next generation sequencing (NGS) brings a whole new meaning to “minimal” residual disease in the response assessment of hematologic malignancies. In this study, Dutch researchers used NGS on acute myeloid leukemia (AML) cells of almost 500 patients to discover 89% had at least one mutation at diagnosis, and almost half continued to have identifiable tumor mutations following induction therapy. After excluding common mutations present in age-related clonal hematopoiesis (read: unrelated to their AML), “molecular” residual disease was associated with significantly higher relapse rates (55% versus 32%) and lower overall survival (42% and 66%) at 4 years. And this was significantly more prognostic than traditional flow cytometry. TBL: NGS may identify a greater number of patients with AML who merit more intensive consolidative therapy. | Jongen-Lavrencic, N Engl J Med 2018