Hematology

ELN-DAVID 2025: standardized, genetics-aligned AML MRD guidance

This ELN-DAVID update issues 56 consensus recommendations for AML MRD assessment, aligned with ELN 2022 genetic risk groups. MRD responses are newly categorized qualitatively as optimal, warning, or high risk of treatment failure to guide clinical decisions. Recommendations are tailored by prognostic and genetic subsets, embedding MRD into routine risk assessment and post-therapy monitoring. Ultrahigh-sensitivity NGS-based MRD is specifically recommended for FLT3-ITD–mutated AML after intensive chemotherapy and before allogeneic transplantation. 1

ASC4FIRST: asciminib surpasses standard TKIs in newly diagnosed CML-CP

In ASC4FIRST, asciminib achieved higher week-96 major molecular response than investigator-selected TKIs in newly diagnosed CML-CP (74.1% vs 52.0%). Asciminib also clearly outperformed imatinib (76.2% vs 47.1% MMR at week 96), meeting key secondary endpoints. Compared with second-generation TKIs, asciminib yielded higher MMR (72.0% vs 56.9%), though this secondary endpoint was not powered for definitive significance. Dose reductions and interruptions occurred less often with asciminib than with second-generation TKIs, indicating better long-term tolerability. 2

PD-1–based salvage before ASCT improves outcomes in R/R cHL

This multicenter retrospective cohort included 1,280 relapsed/refractory classical Hodgkin lymphoma patients undergoing ASCT between 2010 and 2022. Twenty-five percent received PD-1 inhibitor–based therapy pre-ASCT, including 10% treated with PD-1 plus chemotherapy. Any PD-1 exposure before ASCT yielded higher 2-year PFS than brentuximab-based salvage or chemotherapy alone (88.2% vs 70.2% and 67.4%; p<0.0001). The PFS benefit persisted in patients already in complete response at transplant, suggesting an effect beyond CR attainment. 3