A Pragmatic Clinical Trial to Prevent Relapse for Myeloid Malignancies With Measurable Disease Prior to Allogeneic Transplant
Key claim: A prospective open-label trial is evaluating whether MRD-guided assignment of post-transplant maintenance therapy reduces relapse in patients with myeloid malignancies undergoing allogeneic HCT.
Abstract
This is a prospective, open-label investigation to determine whether measurable residual disease (MRD) guided assignment of maintenance therapy is effective in patients with myeloid malignancies undergoing allogeneic hematopoietic cell transplantation (HCT). Pre-HCT, patients will undergo usual disease assessments which should include immunophenotypic and/or molecular testing. Based on the results of these tests, patients may or may not be recommended to receive maintenance therapy post-transplant, depending on the presence or absence of a residual malignant clone.
Why this matters
Post-transplant relapse is the dominant failure mode after allo-HCT for myeloid malignancies, and current maintenance practice is largely one-size-fits-all or ad hoc. By prospectively tying maintenance assignment to MRD status, this trial reframes the post-transplant decision from ‘which drug for everyone’ to ‘who needs intensification’ — a structural change that, if positive, would push MRD assessment from prognostic curiosity to mandatory peri-transplant workup for MPN patients.