Adult patients with myeloid malignancy undergoing allo-HSCT while in remission (n=190)
Ultra-deep, error-corrected sequencing for 13 commonly mutated genes in AML prior to myeloablative conditioning (MAC recipients) (n=95)
Ultra-deep, error-corrected sequencing for 13 commonly mutated genes in AML prior to reduced intensity conditioning (RIC recipients) (n=95)
No mutations were detected in 32% of MAC and 37% of RIC recipients; these groups had similar survival (3-year overall survival [OS], 56% v 63). In patients with a detectable mutation (next-generation sequencing [NGS] positive), relapse (3-year cumulative incidence, 19% v 67%) and survival (3-year OS, 61% v 43) was significantly different between the MAC and RIC arms, respectively. In multivariable analysis for NGS-positive patients, adjusting for disease risk and donor group, RIC was significantly associated with increased relapse (hazard ratio [HR], 6.38; 95%), decreased relapse-free survival (HR, 2.94; 95), and decreased OS (HR, 1.97; 95%) compared with MAC. Models of AML MRD also showed benefit for MAC over RIC for those who tested positive.