Post-transplant monitoring of NGS-based measurable residual disease and donor chimerism as a prognostic tool in older patients with AML/MDS
- 1Division of Hemato-Oncology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, 170 Jomaru-Ro, Wonmi-Gu, Bucheon, 14584 Republic of Korea
- 2Division of Hematology-Oncology, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, 59, Daesagwan-ro, Yongsan-gu, Seoul, 04401 Korea
Abstract
Purpose: To evaluate the prognostic value of integrated post-transplant monitoring of NGS-based measurable residual disease (MRD) and donor chimerism in older patients with acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS), undergoing reduced-intensity conditioning (RIC) allogeneic stem cell transplantation (allo-SCT).
Materials and methods: This retrospective study analyzed the clinical outcomes of 113 patients with AML or MDS, aged ≥ 60 years or ≥ 55 years if deemed unfit for standard-intensity conditioning, who underwent RIC allo-SCT. NGS-based MRD testing and donor chimerism were assessed at 3 months post-transplant.
Results: A total of 113 patients participated in the study (median age 63 years; 69.9% with AML); among the 105 patients evaluable at 3 months post-transplantation, MRD positivity occurred in 28 patients (26.7%) and predicted inferior overall survival (hazard ratio [HR] 6.373, 95% confidence interval [CI] 3.005–13.517; P < 0.001), while complete donor chimerism (CDC), achieved in 82 patients (78.1%), predicted improved survival (HR 0.356, 95% CI 0.195–0.916; P = 0.028). MRD positivity remained an independent predictor of survival on multivariate analysis (HR 3.315, 95% CI 1.423–7.230, P = 0.005), while CDC showed a trend toward improved survival that did not reach statistical significance (HR 0.494, 95% CI 0.306–1.009, P = 0.051). Two-year overall survival differed markedly across the four MRD/CDC subgroups, ranging from 85.6% [MRD(–)/CDC( +)] to 13.6% [MRD( +)/CDC(–)] (P < 0.001), with the MRD( +)/CDC(–) group showing the highest 2-year relapse incidence (69.7%).
Conclusion: The combination of NGS-based MRD and chimerism monitoring is a critical prognostic strategy for older patients with AML/MDS undergoing RIC allo-SCT. Early identification of MRD positivity or mixed chimerism allows timely, risk-adapted interventions, including donor lymphocyte infusion, hypomethylating agents, and targeted therapies to reduce relapse and improve survival.
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s44313-026-00187-6.
Related
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- The Clinical Impact of End-of-Consolidation Measurable Residual Disease in High-Risk Pediatric B-Cell Acute Lymphoblastic Leukemia
- Measurable residual disease in chronic lymphocytic leukemia in real-world clinical practice: a single-center experience from 2018–2025
BibTeX
@article{kim2026posttransplant,
title = {{Post-transplant monitoring of NGS-based measurable residual disease and donor chimerism as a prognostic tool in older patients with AML/MDS}},
author = {Se Hyung Kim and Jina Yun and Kyoung Ha Kim and Seug Yun Yoon and Chan Kyu Kim and Seong Kyu Park},
journal = {Blood Research},
year = {2026},
month = oct,
doi = {10.1007/s44313-026-00187-6},
url = {https://doi.org/10.1007/s44313-026-00187-6},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Post-transplant monitoring of NGS-based measurable residual disease and donor chimerism as a prognostic tool in older patients with AML/MDS
AU - Se Hyung Kim
AU - Jina Yun
AU - Kyoung Ha Kim
AU - Seug Yun Yoon
AU - Chan Kyu Kim
AU - Seong Kyu Park
PY - 2026
DA - 2026/10/26
JO - Blood Research
DO - 10.1007/s44313-026-00187-6
UR - https://doi.org/10.1007/s44313-026-00187-6
AB - Purpose: To evaluate the prognostic value of integrated post-transplant monitoring of NGS-based measurable residual disease (MRD) and donor chimerism in older patients with acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS), undergoing reduced-intensity conditioning (RIC) allogeneic stem cell transplantation (allo-SCT). Materials and methods: This retrospective study analyzed the clinical outcomes of 113 patients with AML or MDS, aged ≥ 60 years or ≥ 55 years if deemed unfit for standard-intensity conditioning, who underwent RIC allo-SCT. NGS-based MRD testing and donor chimerism were assessed at 3 months post-transplant. Results: A total of 113 patients participated in the study (median age 63 years; 69.9% with AML); among the 105 patients evaluable at 3 months post-transplantation, MRD positivity occurred in 28 patients (26.7%) and predicted inferior overall survival (hazard ratio [HR] 6.373, 95% confidence interval [CI] 3.005–13.517; P < 0.001), while complete donor chimerism (CDC), achieved in 82 patients (78.1%), predicted improved survival (HR 0.356, 95% CI 0.195–0.916; P = 0.028). MRD positivity remained an independent predictor of survival on multivariate analysis (HR 3.315, 95% CI 1.423–7.230, P = 0.005), while CDC showed a trend toward improved survival that did not reach statistical significance (HR 0.494, 95% CI 0.306–1.009, P = 0.051). Two-year overall survival differed markedly across the four MRD/CDC subgroups, ranging from 85.6% [MRD(–)/CDC( +)] to 13.6% [MRD( +)/CDC(–)] (P < 0.001), with the MRD( +)/CDC(–) group showing the highest 2-year relapse incidence (69.7%). Conclusion: The combination of NGS-based MRD and chimerism monitoring is a critical prognostic strategy for older patients with AML/MDS undergoing RIC allo-SCT. Early identification of MRD positivity or mixed chimerism allows timely, risk-adapted interventions, including donor lymphocyte infusion, hypomethylating agents, and targeted therapies to reduce relapse and improve survival. Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s44313-026-00187-6.
SN - 2287-979X
SN - 2288-0011
ER -