Prognostic value of combined digital PCR and multiparametric flow cytometry monitoring MRD in non-transplant acute myeloid leukemia.

[OBJECTIVE] To evaluate the synergistic prognostic value of digital PCR (dPCR)-based multigene measurable residual disease (MRD) monitoring combined with multiparametric flow cytometry (MFC) in patients with non-transplant acute myeloid leukemia (AML).

[METHODS] This observational cohort study analyzed 86 newly diagnosed AML patients (excluding APL) at the Affiliated Hospital of Hebei University (January 2018-May 2025). MRD was assessed using MFC (threshold: 0.1%) and dPCR (variant allele frequency [VAF] < 0.001%). Outcomes included relapse-free survival (RFS), overall survival (OS), and cumulative relapse rates.

[RESULTS] With a median follow-up time of 18.5 months, dPCR-MRD negativity predicted superior 2-year RFS (67.1% vs 42.3%, HR = 0.365, P = 0.003). Combined MFC/dPCR negativity further enhanced prognostic discrimination (2-year RFS: 68.2% vs 40.5%, HR = 0.323, P = 0.001). Subgroup analysis revealed MFC-driven RFS benefits in intensive chemotherapy (72.2% vs 33.3%, HR = 0.180, P = 0.014), while dual-platform monitoring showed trends favoring non-intensive regimens (58.7% vs 31.7%, HR = 0.407, P = 0.051).

[CONCLUSION] dPCR-MRD monitoring complements MFC for the stratification of risk of relapse, particularly among non-transplant AML patients. Dual-platform integration improves predictive accuracy, supporting personalized MRD-guided strategies.