Testing MRD positive after decitabine plus venetoclax means leukemia cells are still detectable, which is understandably concerning. For a fit patient, this is an important signal that the current treatment may not be achieving deep enough remission — and that it's time to explore next steps with your care team.
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Testing MRD positive after decitabine plus venetoclax means leukemia cells are still detectable, which is understandably concerning. For a fit patient, this is an important signal that the current treatment may not be achieving deep enough remission — and that it's time to explore next steps with your care team.
Here are some options that are typically considered for fit AML patients in this situation:
- Stem cell transplant — If remission has been achieved but MRD is still positive, a stem cell transplant (using a matched donor) may be recommended to deepen and sustain remission
- Targeted therapies based on gene mutations — Depending on your genetic profile:
- IDH1 mutation: Tibsovo (ivosidenib) or olutasidenib
- IDH2 mutation: Idhifa (enasidenib)
- FLT3 mutation: Xospata (gilteritinib) or Rydapt (midostaurin)
- Clinical trials — These can offer access to newer treatment combinations and are often a strong option for relapsed or refractory AML
- Alternative chemotherapy regimens — Switching to a different induction or salvage chemotherapy approach
Being "fit" is actually a real advantage here — it opens the door to more intensive options like transplant that may not be suitable for everyone. It's worth asking your oncologist specifically about genetic mutation testing if it hasn't been done recently, as mutations can sometimes change at relapse and new targeted therapy options may apply.
MRD monitoring is a powerful tool — a positive result doesn't necessarily mean treatment has failed entirely, but it does give your team important information to act on quickly and personalize your care.
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