{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T03:41:26Z","timestamp":1792813286499,"version":"4.5.0"},"reference-count":50,"publisher":"American Medical Association (AMA)","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA"],"published-print":{"date-parts":[[2023,3,7]]},"abstract":"\n Importance<\/jats:title>\n Preventing relapse for adults with acute myeloid leukemia (AML) in first remission is the most common indication for allogeneic hematopoietic cell transplant. The presence of AML measurable residual disease (MRD) has been associated with higher relapse rates, but testing is not standardized.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To determine whether DNA sequencing to identify residual variants in the blood of adults with AML in first remission before allogeneic hematopoietic cell transplant identifies patients at increased risk of relapse and poorer overall survival compared with those without these DNA variants.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n \n In this retrospective observational study, DNA sequencing was performed on pretransplant blood from patients aged 18 years or older who had undergone their first allogeneic hematopoietic cell transplant during first remission for AML associated with variants in\n FLT3, NPM1, IDH1, IDH2,<\/jats:italic>\n or\n KIT<\/jats:italic>\n at 1 of 111 treatment sites from 2013 through 2019. Clinical data were collected, through May 2022, by the Center for International Blood and Marrow Transplant Research.\n <\/jats:p>\n <\/jats:sec>\n \n Exposure<\/jats:title>\n Centralized DNA sequencing of banked pretransplant remission blood samples.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary outcomes were overall survival and relapse. Day of transplant was considered day 0. Hazard ratios were reported using Cox proportional hazards regression models.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Of 1075 patients tested, 822 had\n FLT3<\/jats:italic>\n internal tandem duplication (\n FLT3-<\/jats:italic>\n ITD) and\/or\n NPM1<\/jats:italic>\n mutated AML (median age, 57.1 years, 54% female). Among 371 patients in the discovery cohort, the persistence of\n NPM1<\/jats:italic>\n and\/or\n FLT3<\/jats:italic>\n -ITD variants in the blood of 64 patients (17.3%) in remission before undergoing transplant was associated with worse outcomes after transplant (2013-2017). Similarly, of the 451 patients in the validation cohort who had undergone transplant in 2018-2019, 78 patients (17.3%) with residual\n NPM1<\/jats:italic>\n and\/or\n FLT3<\/jats:italic>\n -ITD variants had higher rates of relapse at 3 years (68% vs 21%; difference, 47% [95% CI, 26% to 69%]; HR, 4.32 [95% CI, 2.98 to 6.26];\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001) and decreased survival at 3 years (39% vs 63%; difference, \u221224% [2-sided 95% CI, \u221239% to \u22129%]; HR, 2.43 [95% CI, 1.71 to 3.45];\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n \n Among patients with acute myeloid leukemia in first remission prior to allogeneic hematopoietic cell transplant, the persistence of\n FLT3<\/jats:italic>\n internal tandem duplication or\n NPM1<\/jats:italic>\n variants in the blood at an allele fraction of 0.01% or higher was associated with increased relapse and worse survival compared with those without these variants. Further study is needed to determine whether routine DNA-sequencing testing for residual variants can improve outcomes for patients with acute myeloid leukemia.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jama.2023.1363","type":"journal-article","created":{"date-parts":[[2023,3,7]],"date-time":"2023-03-07T11:31:55Z","timestamp":1678188715000},"page":"745","source":"Crossref","is-referenced-by-count":154,"title":["DNA Sequencing to Detect Residual Disease in Adults With Acute Myeloid Leukemia Prior to Hematopoietic Cell Transplant"],"prefix":"10.1001","volume":"329","author":[{"given":"Laura W.","family":"Dillon","sequence":"first","affiliation":[{"name":"Laboratory of Myeloid Malignancies, Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gege","family":"Gui","sequence":"additional","affiliation":[{"name":"Laboratory of Myeloid Malignancies, Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland"},{"name":"Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristin M.","family":"Page","sequence":"additional","affiliation":[{"name":"Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota"},{"name":"Medical College of Wisconsin, Milwaukee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niveditha","family":"Ravindra","sequence":"additional","affiliation":[{"name":"Laboratory of Myeloid Malignancies, Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zo\u00eb C.","family":"Wong","sequence":"additional","affiliation":[{"name":"Laboratory of Myeloid Malignancies, Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgia","family":"Andrew","sequence":"additional","affiliation":[{"name":"Laboratory of Myeloid Malignancies, Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Devdeep","family":"Mukherjee","sequence":"additional","affiliation":[{"name":"Laboratory of Myeloid Malignancies, Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott L.","family":"Zeger","sequence":"additional","affiliation":[{"name":"Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Firas","family":"El Chaer","sequence":"additional","affiliation":[{"name":"University of Virginia, Charlottesville"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Spellman","sequence":"additional","affiliation":[{"name":"Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota"},{"name":"National Marrow Donor Program, Minneapolis, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alan","family":"Howard","sequence":"additional","affiliation":[{"name":"Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota"},{"name":"National Marrow Donor Program, Minneapolis, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen","family":"Chen","sequence":"additional","affiliation":[{"name":"National Marrow Donor Program, Minneapolis, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffery","family":"Auletta","sequence":"additional","affiliation":[{"name":"Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota"},{"name":"The Ohio State University College of Medicine, Columbus"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven M.","family":"Devine","sequence":"additional","affiliation":[{"name":"Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio Martin","family":"Jimenez Jimenez","sequence":"additional","affiliation":[{"name":"Sylvester Comprehensive Cancer Center, Miami, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcos J. 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