Zachary D Epstein-Peterson1, Sean M Devlin2, Eytan M Stein3, Elihu Estey4, Martin S Tallman5. 1. Department of Medicine, Memorial Sloan Kettering Cancer Center, USA. Electronic address: epsteinz@mskcc.org. 2. Department of Biostatistics, Memorial Sloan Kettering Cancer Center, USA. Electronic address: devlins@mskcc.org. 3. Department of Medicine, Memorial Sloan Kettering Cancer Center, USA; Division of Hematologic Oncology, Leukemia Service, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA; Department of Medicine, Weill Cornell Medical College, 1300 York Ave, New York, NY, 10065, USA. Electronic address: steine@mskcc.org. 4. Seattle Cancer Center Alliance, UW Box 358081, Mailstop G3-200, 825 Eastlake Ave E., Seattle, WA, 98109, USA. Electronic address: EEstey@seattlecca.org. 5. Department of Medicine, Memorial Sloan Kettering Cancer Center, USA; Division of Hematologic Oncology, Leukemia Service, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA; Department of Medicine, Weill Cornell Medical College, 1300 York Ave, New York, NY, 10065, USA. Electronic address: tallmanM@mskcc.org.
Abstract
PURPOSE: Measurable residual disease (MRD) has prognostic importance for patients with acute myeloid leukemia (AML). How leukemia providers incorporate MRD into routine practice remains undefined. PATIENTS AND METHODS: A survey was developed and distributed to a large sample of leukemia physicians. Demographic information was collected along with details concerning MRD practices. A multivariable logistic regression model evaluated provider characteristics predictive of MRD utilization. RESULTS: 268 responses were received (response rate of 41%). 69% of providers reported routine use of MRD in management of AML, most commonly (90%) for its role in guiding therapy; providers who did not use MRD routinely most frequently cited inadequate resources (58%). Providers utilized flow cytometry- more than polymerase chain reaction-based assays with nucleophosmin-1 being the most common target with the latter. We found substantial variability in how MRD affected clinical decision making, particularly in pre- and post-transplant scenarios. CONCLUSIONS: MRD was frequently used in making treatment decisions and in estimating prognosis. However, there was lack of uniformity in these practices. Standardization of assays, adoption of requisite technology, and dissemination of data about the value of MRD use would likely increase usage of MRD in the care of patients with AML.
PURPOSE: Measurable residual disease (MRD) has prognostic importance for patients with acute myeloid leukemia (AML). How leukemia providers incorporate MRD into routine practice remains undefined. PATIENTS AND METHODS: A survey was developed and distributed to a large sample of leukemia physicians. Demographic information was collected along with details concerning MRD practices. A multivariable logistic regression model evaluated provider characteristics predictive of MRD utilization. RESULTS: 268 responses were received (response rate of 41%). 69% of providers reported routine use of MRD in management of AML, most commonly (90%) for its role in guiding therapy; providers who did not use MRD routinely most frequently cited inadequate resources (58%). Providers utilized flow cytometry- more than polymerase chain reaction-based assays with nucleophosmin-1 being the most common target with the latter. We found substantial variability in how MRD affected clinical decision making, particularly in pre- and post-transplant scenarios. CONCLUSIONS: MRD was frequently used in making treatment decisions and in estimating prognosis. However, there was lack of uniformity in these practices. Standardization of assays, adoption of requisite technology, and dissemination of data about the value of MRD use would likely increase usage of MRD in the care of patients with AML.
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