Measurable Residual Mutated NPM1 before Allogeneic Transplant for Acute Myeloid Leukemia

Measurable residual disease (MRD) testing before allogeneic hematopoietic cell transplant (alloHCT) for persistence of mutated NPM1 or FLT3 internal tandem duplication (FLT3-ITD) can identify patients with acute myeloid leukemia (AML) in complete remission (CR) at highest risk of relapse and death. NPM1 mutations, seen in ~30% of adult AML cases, often co-occur with FLT3-ITD. Quantitative RT-PCR assays are currently recommended for NPM1 MRD testing, while FLT3-ITD MRD testing is DNA-based using next generation sequencing (NGS). DNA-based NGS-MRD assays for mutated NPM1 MRD testing may have several advantages but require validation. We performed NPM1 MRD detection in blood collected from patients with AML during first CR (CR1) prior to alloHCT on a subset of patients from the Pre-MEASURE study (PMID: 36881031) using a highly-sensitive, commercially available DNA-based NPM1 NGS-MRD assay.