MRD-guided post-transplant maintenance assignment

Current understanding

Rather than offering uniform post-transplant maintenance, this strategy uses pre- and/or post-HCT measurable residual disease (MRD) status to assign patients to specific maintenance regimens, aiming to intensify therapy for high-risk (MRD+) patients while sparing low-risk patients excess toxicity. A pragmatic open-label trial is prospectively testing this MRD-directed assignment in myeloid malignancies (including MPNs) undergoing allogeneic HCT — early-phase evidence, with relapse reduction as the primary question. The approach sits at the interface of the decision layer (MRD as a risk-stratifier) and the execution layer (which maintenance to deliver).

Evidence log

• 2026-07-16 — Study of Tagraxofusp for Post-Transplant Maintenance for Patients With CD 123+ AML, MDS, MF and CMML (HSCT 002): cross-connection with tagraxofusp-post-transplant-maintenance: Tagraxofusp is a candidate maintenance agent that could slot into MRD-guided post-HCT assignment frameworks for CD123+ disease, alongside HMA and other maintenance arms. (novelty: 3)
• 2026-06-23 — A Pragmatic Clinical Trial to Prevent Relapse for Myeloid Malignancies With Measurable Disease Prior to Allogeneic Transplant: cross-connection with post-transplant-peginfa-maintenance-mf: PegINFa maintenance is another candidate post-HCT maintenance modality that could plausibly be slotted into an MRD-directed assignment framework for MPN/MF patients. (novelty: 3)

Open questions

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