AML with detectable measurable residual disease (MRD) after induction or consolidation —...

Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.

ID	`RF-AML-MEASURABLE-RESIDUAL-DISEASE`
Type	Red flag
Status	reviewed 2026-04-27 \| pending_clinical_signoff
Diseases	`DIS-AML`
Sources	`SRC-ELN-AML-2022` `SRC-NCCN-AML-2025` `SRC-QUAZAR-WEI-2020`

Red Flag Origin

Definition	AML with detectable measurable residual disease (MRD) after induction or consolidation — defined per ELN 2021 MRD working-party as ≥0.1% MFC-MRD by multiparametric flow cytometry, OR molecular MRD ≥10⁻³ for NPM1/CBF/KMT2A-rearranged transcripts (RT-qPCR), OR persistent detectable WT1 transcript >2.5×10⁻³ in PB. MRD-positivity post-CR1 is the strongest single predictor of relapse (RFS hazard ratio 3-5×) and defines the population that benefits from consolidation intensification: alloHCT in CR1 (per ELN 2022) over standard HiDAC consolidation, or switch to MRD-directed maintenance (oral azacitidine post-consolidation per QUAZAR; gilteritinib post-alloHCT for FLT3-ITD per MORPHO).
Clinical direction	intensify
Category	high-risk-biology
Shifts algorithm	ALGO-AML-1L, ALGO-AML-2L

Trigger Logic

{
  "any_of": [
    {
      "finding": "aml_mrd_positive",
      "value": true
    },
    {
      "finding": "aml_mrd_status",
      "value": "positive"
    },
    {
      "finding": "aml_mrd_post_induction",
      "value": "positive"
    },
    {
      "comparator": ">=",
      "finding": "mfc_mrd_percent",
      "threshold": 0.1
    },
    {
      "comparator": ">=",
      "finding": "molecular_mrd_npm1",
      "threshold": 0.001
    },
    {
      "comparator": ">",
      "finding": "wt1_transcript_pb",
      "threshold": 0.0025
    }
  ],
  "type": "biomarker"
}

Notes

Timing matters: MRD assessed after induction (cycle 1 day 28 BM) and after each consolidation cycle. MRD-positive after induction in favorable-risk (NPM1+/FLT3-ITD-WT or CBF) does not automatically mean alloHCT — repeat after consolidation; persistent or rising MRD is the trigger. Method choice: NPM1-mut → RT-qPCR for the NPM1 transcript (most sensitive, ≤10⁻⁵); CBF (RUNX1::RUNX1T1, CBFB::MYH11) → RT-qPCR for the fusion; otherwise MFC-MRD with LAIP/DfN gating (sensitivity 10⁻³ to 10⁻⁴). Emerging: error-corrected NGS for non-NPM1 mutations (DTA mutations DNMT3A/TET2/ASXL1 are clonal-hematopoiesis-related, do NOT count as MRD-positive). RF coexists with RF-AML-FLT3-ACTIONABLE (different axes; FLT3-mut + MRD-positive = strong alloHCT in CR1 + post-transplant gilteritinib maintenance per MORPHO).

Used By

Algorithms

ALGO-AML-2L - ALGO-AML-2L

Red flag

RF-AML-CORE-BINDING-FACTOR-FAVORABLE - AML with core-binding-factor (CBF) cytogenetics: t(8;21)(q22;q22.1) with RUNX1::RUNX1T1 f...