Figure 3

MG-MRD correlates with pathological diagnosis and relapse risk. (a) Peripheral blood-based MG-MRD testing has good concordance with pathologist BM diagnosis pre-SCT. Blue: pathologist determination of active disease based on clinical examination of BM (Path+), but negative for peripheral blood MRD testing. Purple: both BM pathological diagnosis and MRD positive. Red: negative for active AML by pathologist examination (‘remission marrow’), but positive for residual disease by peripheral blood-based MRD testing. (b) MG-MRD can identify patients mistakenly classified as low risk by WT1 MRD. Patients with pre-SCT positivity for WT1 represent the high-risk group. MG-MRD testing can identify additional high-risk individuals from the ‘low risk’ WT1-negative group. The mortality in the additional nine patients (12%) reclassified as high risk was 100%. Six of those nine patients reclassified as high risk by MG-MRD were in a CR pre-transplant. (c) Pre-SCT MG-MRD testing improves prediction of early clinical relapses post SCT. All 28 relapses post SCT are plotted by day of clinical relapse aligned with the result of pre-SCT MRD testing. MG-MRD prior to transplantation correctly predicted all relapses in the first 180 days after SCT and was particularly useful in correctly identifying those at risk of early (that is, before median relapse of 99 days) relapse but not identified by WT1 testing. Patients relapsing at 33, 56, 59, 87, 91, 122, 181, 303, 304, 493 and 1089 days post SCT were in a CR prior to SCT (bold).