We aimed to investigate outcomes of different post-remission treatment (PRT) choices based on dynamic measurable residual disease (MRD) by multiparameter flow cytometry in favorable-risk AML (FR-AML). Four hundred and three younger patients with FR-AML in first complete remission (CR1) were enrolled in this registry-based cohort study, including 173 who received chemotherapy (CMT), 92 autologous stem cell transplantation (auto-SCT), and 138 allogeneic SCT (allo-SCT). The primary endpoint was the 5-year overall survival (OS). Subgroup analyses were performed based on dynamic MRD after the 1st, 2nd, and 3rd courses of chemotherapy. In subgroups of patients with negative MRD after 1 or 2 course of chemotherapy, comparable OS was observed among the CMT, auto-SCT, and allo-SCT groups (p = 0.340; p = 0.627, respectively). But CMT and auto-SCT had better graft-versus-host-disease-free, relapse-free survival (GRFS) than allo-SCT in both subgroups. For patients with negative MRD after three courses of chemotherapy, allo-SCT had better disease-free-survival than CMT (p = 0.009). However, OS was comparable among the three groups (p = 0.656). For patients with persistently positive MRD after 3 courses of chemotherapy or recurrent MRD, allo-SCT had better OS than CMT and auto-SCT (p = 0.011; p = 0.029, respectively). Dynamic MRD might improve therapy stratification and optimize PRT selection for FR-AML in CR1.

我们的目的是通过多参数流式细胞术研究基于动态可测量残留病（MRD）的不同缓解后治疗（PRT）选择在有利风险AML（FR-AML）中的结果。这项基于登记的队列研究纳入了 403 名首次完全缓解 (CR1) 的 FR-AML 年轻患者，其中 173 名接受化疗 (CMT)、92 名接受自体干细胞移植 (auto-SCT) 和 138 名接受同种异体治疗的患者SCT（异基因 SCT）。主要终点是 5 年总生存期 (OS)。根据第1、2、3个疗程化疗后的动态MRD进行亚组分析。在 1 或 2 个疗程化疗后 MRD 阴性的患者亚组中，CMT、auto-SCT 和 allo-SCT 组之间观察到相当的 OS（分别为p = 0.340； p = 0.627）。但在两个亚组中，CMT 和自体 SCT 的无移植物抗宿主病、无复发生存 (GRFS) 均优于同种异体 SCT。对于三个疗程化疗后 MRD 阴性的患者，allo-SCT 的无病生存率优于 CMT（ p = 0.009）。然而，三组之间的 OS 具有可比性 ( p = 0.656)。对于3个疗程化疗后MRD持续阳性或复发MRD的患者，allo-SCT的OS优于CMT和auto-SCT（分别为p = 0.011； p = 0.029）。动态 MRD 可能会改善 CR1 期 FR-AML 的治疗分层并优化 PRT 选择。