2026 ASH®
Annual Meeting & Exposition December 12-15, 2026 ▪ New Orleans, Louisiana

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Paper Details

Abstracts, authors, affiliations, and disclosures.

SESSION

732. Allogeneic Transplantation: Disease Response and Comparative Treatment Studies: Allogeneic Transplantation for Myeloid Malignancies: Timing, Donors, and Disease Control

Program: Oral Abstract Session
Sunday, December 13, 2026
04:30 p.m. - 06:00 p.m.
MCCNO - Great Hall AD

KEYWORDS

Technology and Procedures, Molecular Testing, Treatment Considerations, Drug Development, Biological Therapies, Transplantation, Non-Biological Therapies, Chemotherapy, Adverse Events, Diseases, Lymphoid Malignancies, Lymphoid Leukemias, Myeloid Malignancies, Acute Myeloid Malignancies, Chronic Myeloid Malignancies, Measurable Residual Disease, Research, AML, MDS, Clinical Research, Clinical Trials, Epidemiology, Real-World Evidence, Study Population, Human, Adult
PAPER

716 Pre-transplant flow cytometry in AML patients undergoing allogeneic HCT after hypomethylating agent and venetoclax therapy

AUTHORS

Jesse M Tettero, Gege Gui, PhD2, Laura W Dillon, PhD3, Rasha W Al-Ali, MSc4, Kai Yu5, Michael R. Grunwald, MD6, Elizabeth Florence Krakow, MD,CM, MSc7, Elizabeth A Griffiths, MD8, Alexandra Gomez-Arteaga, MD9, Rahul Vedula, MD10, Melhem Solh, MD11, Amandeep Salhotra, MD12, Nelli Bejanyan, MD13, Lori Muffly, MD14, Antonio M. Jimenez Jimenez, MD15, Michael W. Drazer, MD, PhD16, Yi-Bin Chen, MD,MS17, Aaron C. Logan, MD, PhD, MPhil18, Reena Jayani-Kosarzycki, MD, MSCI19, Sophia Rebecca Balderman, MD20, James Stewart Blachly, MD21, Brian C Shaffer, MD, MS22, Lawrence J Druhan, PhD23, Cecilia CS Yeung, MD, Professor Pathology24, Vanessa E Kennedy, MD25, Hetty Carraway, MD, MBA26, Sandeep Gurbuxani, MD, PhD27, Melissa Tjota28, Farah Sahoo29, Max Smith30, Alexander E. Perl, MD31, Geoffrey Fell32, Brian A Jonas, MD, PhD33, Brittany Knick Ragon, MD34, Alice Scott Mims, MD35, Uma Borate, MBBS, MSc36, Gabriel Mannis I, MD37, Maximilian Stahl, MD38, Brandon James Aubrey, MBBS PhD FRACP FRCPA39, Paul Koller, MD40, Andrew Artz, MD,MS41, Monzr M. M Al Malki, MD42, Timothy Graubert, MD43, Peter Westervelt44, Philip Amrein, MD45, Andrew M Brunner, MD46, Gabriela Soriano Hobbs, MD47, Rupa Narayan, MD48, Michelle Hyunju Lee, MD49, Peter G. Miller, MD,PhD50, Richard Hao51, Matthew Weinstock, MD52, Andrew Matthews, MD53, Donna Neuberg, ScD54, Anthony Selwyn Stein, MD55, Abigail Marola56, Ibrahim Aldoss, MD57, Areej R El-Jawahri, MD58, Ntasha Roy, MBBS, MHA59, Monica Singh, MBBS, DNB60, Jackie Bjerke61, Stephanie Bo-Subait62, Bergetta Dietel63, Gabrielle Giammarino64, Emily Heying Chihak65, Jianqun Kou66, Danielle O'Donnell Vitali67, Wael Saber, MD68, Stephen R. Spellman, MBS69, Brenna K Tesch70, Jenny Vogel71, Stephanie Waldvogel72, Syreeta Weatherspoon73, Jeffery J. Auletta, MD74, Steven Michael Devine, MD75, Brent Wood, MD, PhD76, Amir T. Fathi, MD77, Christopher S Hourigan, DM DPhil FRCP78

AFFILIATIONS

1 Fralin Biomedical Research Institute, Virginia Tech FBRI Cancer Research Center, Washington, District of Columbia, United States
2 Fralin Biomedical Research Institute, Virginia Tech FBRI Cancer Research Center, Washington, District of Columbia, United States
3 Fralin Biomedical Research Institute, Virginia Tech FBRI Cancer Research Center, Washington, District of Columbia, United States
4 Fralin Biomedical Research Institute, Virginia Tech FBRI Cancer Research Center, Washington, District of Columbia, United States
5 Fralin Biomedical Research Institute, Virginia Tech FBRI Cancer Research Center, Washington, District of Columbia, United States
6 Atrium Health Levine Cancer Institute, Charlotte, North Carolina, United States
7 Fred Hutch Cancer Center, Seattle, Washington, United States
8 Roswell Park Comprehensive Cancer Center, Buffalo, New York, United States
9 Weill Cornell Medicine/ New York Presbyterian-Hospital, New York, New York, United States
10 Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, United States
11 Blood and Marrow Transplant Program, Northside Hospital, Atlanta, Georgia, United States
12 City of Hope, Duarte, California, United States
13 Department of Blood and Marrow Transplantation and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, Florida, United States
14 Stanford University, Palo Alto, California, United States
15 Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida, United States
16 University of Chicago, Chicago, Illinois, United States
17 Massachusetts General Hospital, Boston, Massachusetts, United States
18 University of California, San Francisco, California, United States
19 Vanderbilt University, Nashville, Tennessee, United States
20 Taussig Cancer Institute, The Cleveland Clinic Foundation, Cleveland, Ohio, United States
21 The Ohio State University James Comprehensive Cancer Center, Columbus, Ohio, United States
22 Memorial Sloan Kettering Cancer Center, New York, New York, United States
23 Atrium Health Levine Cancer Institute, Charlotte, North Carolina, United States
24 Fred Hutch Cancer Center, Seattle, Washington, United States
25 Stanford University, Palo Alto, California, United States
26 Taussig Cancer Institute, The Cleveland Clinic Foundation, Cleveland, Ohio, United States
27 University of Chicago, Chicago, Illinois, United States
28 University of Chicago, Chicago, Illinois, United States
29 Fred Hutch Cancer Center, Seattle, Washington, United States
30 Fred Hutch Cancer Center, Seattle, Washington, United States
31 Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
32 Dana-Farber Cancer Institute, Boston, Massachusetts, United States
33 University of California Davis School of Medicine, Sacramento, California, United States
34 Atrium Health Levine Cancer Institute, Wake Forest University School of Medicine, Charlotte, North Carolina, United States
35 The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, United States
36 The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, United States
37 Stanford Cancer Institute, Stanford University, Stanford, California, United States
38 Dana-Farber Cancer Institute, Boston, Massachusetts, United States
39 Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts, United States
40 City of Hope National Medical Center, Duarte, California, United States
41 City of Hope National Medical Center, Duarte, California, United States
42 City of Hope National Medical Center, Duarte, California, United States
43 Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts, United States
44 Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts, United States
45 Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts, United States
46 Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts, United States
47 Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts, United States
48 Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts, United States
49 Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts, United States
50 Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts, United States
51 Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts, United States
52 Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
53 Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
54 Dana-Farber Cancer Institute, Boston, Massachusetts, United States
55 City of Hope National Medical Center, Duarte, California, United States
56 Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts, United States
57 City of Hope National Medical Center, Duarte, California, United States
58 Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts, United States
59 Children’s Hospital of Los Angeles, Los Angeles, California, United States
60 Children’s Hospital of Los Angeles, Los Angeles, California, United States
61 Center for International Blood and Marrow Transplant Research (CIBMTR), National Marrow Donor Program (NMDP), Minneapolis, Minnesota, United States
62 Center for International Blood and Marrow Transplant Research (CIBMTR), National Marrow Donor Program (NMDP), Minneapolis, Minnesota, United States
63 Center for International Blood and Marrow Transplant Research (CIBMTR), National Marrow Donor Program (NMDP), Minneapolis, Minnesota, United States
64 Center for International Blood and Marrow Transplant Research (CIBMTR), National Marrow Donor Program (NMDP), Minneapolis, Minnesota, United States
65 Center for International Blood and Marrow Transplant Research (CIBMTR), National Marrow Donor Program (NMDP), Minneapolis, Minnesota, United States
66 Center for International Blood and Marrow Transplant Research (CIBMTR), National Marrow Donor Program (NMDP), Minneapolis, Minnesota, United States
67 Center for International Blood and Marrow Transplant Research (CIBMTR), National Marrow Donor Program (NMDP), Minneapolis, Minnesota, United States
68 Center for International Blood and Marrow Transplant Research (CIBMTR), National Marrow Donor Program (NMDP), Minneapolis, Minnesota, United States
69 Center for International Blood and Marrow Transplant Research (CIBMTR), National Marrow Donor Program (NMDP), Minneapolis, Minnesota, United States
70 Center for International Blood and Marrow Transplant Research (CIBMTR), National Marrow Donor Program (NMDP), Minneapolis, Minnesota, United States
71 Center for International Blood and Marrow Transplant Research (CIBMTR), National Marrow Donor Program (NMDP), Minneapolis, Minnesota, United States
72 Center for International Blood and Marrow Transplant Research (CIBMTR), National Marrow Donor Program (NMDP), Minneapolis, Minnesota, United States
73 Center for International Blood and Marrow Transplant Research (CIBMTR), National Marrow Donor Program (NMDP), Minneapolis, Minnesota, United States
74 Center for International Blood and Marrow Transplant Research (CIBMTR), National Marrow Donor Program (NMDP), Minneapolis, Minnesota, United States
75 Center for International Blood and Marrow Transplant Research (CIBMTR), National Marrow Donor Program (NMDP), Minneapolis, Minnesota, United States
76 Children’s Hospital of Los Angeles, Los Angeles, California, United States
77 Massachusetts General Hospital, Boston, Massachusetts, United States
78 Fralin Biomedical Research Institute, Virginia Tech FBRI Cancer Research Center, Washington, District of Columbia, United States

ABSTRACT

Introduction

Pre-transplant measurable residual disease (MRD) assessed by multiparameter flow cytometry (MFC) is an established prognostic marker for relapse and survival in patients (pts) with acute myeloid leukemia (AML) undergoing allogeneic hematopoietic cell transplantation (alloHCT) after intensive chemotherapy (IC). However, the prognostic significance of MFC-MRD following hypomethylating agent plus venetoclax (HMA+VEN), an increasingly used induction strategy for older/unfit and selected younger pts with AML, remains uncertain. Because HMA+VEN induces distinct patterns of marrow recovery and disease clearance compared with IC, the biological interpretation and clinical utility of pre-transplant MFC-MRD may differ.

To address this gap, we evaluated the prognostic value of pre-transplant MFC-MRD in AML pts undergoing alloHCT after HMA+VEN using two prospective multicenter cohorts and compared outcomes with pts receiving IC.

Methods

Pts with AML receiving either HMA+VEN or IC (standard 7+3 or CPX-351) before alloHCT were identified from two prospective cohorts: the multicenter observational MEASURE study (18 U.S. cancer centers, NCT05224661) and the phase II randomized PARADIGM trial evaluating azacitidine plus venetoclax vs IC (9 US cancer centers, NCT04801797). Pts treated with IC with either standard 7+3 or CPX-351 from both cohorts served as a reference group. The analysis focuses on pts with MFC performed while in complete remission (CR, CRi, or CRh) prior to an alloHCT. In MEASURE, MFC was performed according to each center's standard clinical practice and all clinical reports were centrally reviewed for assay quality, methodology, and interpretation. In PARADIGM, pre-alloHCT MFC-MRD was performed and reported centrally at a single reference laboratory. MRD positivity was defined as detection of a leukemia-associated immunophenotype exceeding 0.1% of white blood cells. Patient, disease, and transplant characteristics were compared according to pre-alloHCT MFC results. Landmark post-transplant outcomes included cumulative incidence of relapse (CIR) and overall survival (OS). Outcomes following HMA+VEN were compared with those observed after IC.

Results

The combined HMA+VEN cohort comprised 115 AML pts undergoing alloHCT (70 from MEASURE and 45 from PARADIGM). Median age was 67 years (range 32-79). Pts received a median of 3 HMA+VEN cycles before transplantation in both cohorts (MEASURE: range, 1-12; PARADIGM: range, 2-5 cycles). Within the MEASURE cohort, 53 pts (76%) received azacitidine plus VEN and 17 received decitabine plus VEN.

Among participants in CR following HMA+VEN in the MEASURE cohort, the 1-year CIR post-transplant was 23%. Pre-transplant MFC positivity was detected in 10/70 pts (14%) treated with HMA+VEN and was independently associated with a significantly higher risk of post-transplant relapse (HR 3.08, 95% CI 1.08–8.80; P=0.04) compared to those testing negative. With median follow-up of 17.3mo from transplant, no significant difference in OS (HR 2, 95% CI 0.7–5.9; P=0.2) was detectable. Similar findings were observed in the PARADIGM cohort (median post-transplant follow-up: 17.0 mos) where of the 41 pts who tested negative on pre-alloHCT MFC-MRD only 3 experienced relapse (7%). 

When compared with pts receiving IC in MEASURE (n= 133), the prognostic impact of pre-transplant MFC testing was similar for pts in remission after HMA+VEN. MFC-negative pts pre-transplant had comparable post-transplant relapse risk and survival regardless of induction strategy (CIR IC at 1yr 9% vs HMA+VEN 12%, P=0.7; OS IC 81% vs HMA+VEN 81%, P=0.97), whereas MRD-positive pts had inferior outcomes across both treatment approaches.

Conclusions

In this combined prospective analysis of the MEASURE and PARADIGM clinical cohorts, pre-transplant MFC testing retained strong prognostic value in pts with AML undergoing alloHCT in remission after HMA+VEN therapy. Across both of these contemporary protocols, MFC negativity pre-alloHCT was consistently associated with low relapse risk after transplantation. Importantly, pts achieving MFC negative remission following HMA+VEN demonstrated post-transplant outcomes comparable to those achieving that response after IC, supporting the biological and clinical relevance of such testing irrespective of induction strategy. These findings support the expansion of pre-transplant MFC-MRD assessment for risk stratification and transplant decision-making also in AML pts treated to CR with HMA+VEN.

DISCLOSURES

Jesse M Tettero: No relevant conflicts of interest to declare.
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