The majority of patients with acute myeloid leukaemia (AML) obtain a first complete remission (CR) with intensive induction chemotherapy. Despite post-remission treatment with allogeneic hematopoietic stem cell transplantation (alloSCT), the incidence of relapse remains considerable and depends on the risk of the AML. In addition, the assessment of the quality of CR with measurable residual disease (MRD) has become pivotal in the prognostication of AML patients. MRD may be detected with multiparametric flow cytometry and/or molecular methods including qPCR for specific mutations or next-generation sequencing. Patients with MRD have a high risk of short-term AML recurrence and may benefit from personalised application of post-remission treatment with alloSCT. The graft-versus-leukaemia effect of alloSCT appears to be virtually similar in both MRD positive and MRD negative patients suggesting that alloSCT could be applied not only based on the risk of the disease and quality of remission, but also on the risk of the treatment. Such a risk-adapted approach is recommended for the clinical assessment of all AML patients and should include AML risk, MRD status, and the risk for non-relapse mortality, preferably addressed by dedicated risk scores.
(BELG J HEMATOL 2020;11(4):147–52)