Minimal/Measurable Residual Disease Monitoring in <i>NPM1</i>-Mutated Acute Myeloid Leukemia: A Clinical Viewpoint and Perspectives

• Main Authors: Fabio Forghieri, Patrizia Comoli, Roberto Marasca, Leonardo Potenza, Mario Luppi
• Format: Article
• Language: English
• Published: MDPI AG 2018-11-01
• Series: International Journal of Molecular Sciences
• Subjects: <i>NPM1</i>-mutated acute myeloid leukemia; molecular minimal/measurable residual disease monitoring; prognostic thresholds and timepoints; intensive chemotherapy; allogeneic hematopoietic stem cell transplantation; clinical outcome
• Online Access: https://www.mdpi.com/1422-0067/19/11/3492

Acute myeloid leukemia (AML) with <i>NPM1</i> gene mutations is currently recognized as a distinct entity, due to its unique biological and clinical features. We summarize here the results of published studies investigating the clinical application of minimal/measurable residual disease (MRD) in patients with <i>NPM1</i>-mutated AML, receiving either intensive chemotherapy or hematopoietic stem cell transplantation. Several clinical trials have so far demonstrated a significant independent prognostic impact of molecular MRD monitoring in <i>NPM1</i>-mutated AML and, accordingly, the Consensus Document from the European Leukemia Net MRD Working Party has recently recommended that <i>NPM1</i>-mutated AML patients have MRD assessment at informative clinical timepoints during treatment and follow-up. However, several controversies remain, mainly with regard to the most clinically significant timepoints and the MRD thresholds to be considered, but also with respect to the optimal source to be analyzed, namely bone marrow or peripheral blood samples, and the correlation of MRD with other known prognostic indicators. Moreover, we discuss potential advantages, as well as drawbacks, of newer molecular technologies such as digital droplet PCR and next-generation sequencing in comparison to conventional RQ-PCR to quantify <i>NPM1</i>-mutated MRD. In conclusion, further prospective clinical trials are warranted to standardize MRD monitoring strategies and to optimize MRD-guided therapeutic interventions in <i>NPM1</i>-mutated AML patients.