The prognostic value of maintaining minimal residual disease status in patients with acute myeloid leukaemia receiving azacitidine-based therapy

Multiparametric flow cytometry (MFC) is the core method for monitoring measurable residual disease (MRD) in acute myeloid leukemia (AML), yet its clinical value during azacitidine-based maintenance therapy lacks sufficient real-world data support. This study retrospectively enrolled 129 AML patients who received azacitidine maintenance therapy at the First Hospital of Lanzhou University from January 2019 to May 2025, aiming to explore the aforementioned clinical value and related prognostic factors. The primary endpoints of the study were overall survival (OS), relapse-free survival (RFS), and disease-free survival (DFS); the secondary endpoints included time to MRD negativity, duration of MRD negativity, and the incidence of adverse events.The results showed that azacitidine-based maintenance therapy could bring significant clinical benefits to AML patients. MRD status and duration of response (DoR) during the maintenance phase were core prognostic biomarkers for AML patients receiving this treatment. Among them, the duration of MRD negativity was predictive of longer OS, DFS, and RFS, which could effectively reflect a robust therapeutic response and is recommended as a dynamic endpoint for evaluating maintenance therapy efficacy. In terms of safety, the incidence of serious adverse events in both the maintenance group and the control group was within a manageable range, with no intolerable safety issues. In conclusion, azacitidine-based maintenance therapy for AML has a favorable benefit-risk ratio, and MRD-related indicators can serve as key reference criteria for evaluating the efficacy and prognosis of this treatment regimen.