Consolidation cycles, measurable residual disease, and DNMT3A/ASXL1 mutations independently predict relapse-free survival in older adults with acute myeloid leukemia

Older adults with acute myeloid leukemia (AML) remain prone to relapse despite achieving remission. We retrospectively analyzed 102 consecutive AML patients ≥ 60 years from two centers in Shanxi, China, who attained complete remission (CR/CRi) after induction with either "3 + 7" or venetoclax plus azacitidine (VEN-AZA). Clinical variables, next-generation sequencing, measurable residual disease (MRD) by multiparameter flow cytometry, and consolidation details were evaluated. Median relapse-free survival (RFS) was 9.7 months (95% CI 7.2-12.2). On multivariable analysis, DNMT3A (HR 2.49, p = 0.005) and ASXL1 (HR 2.88, p = 0.016) mutations and MRD positivity (HR 1.95, p = 0.027) predicted inferior RFS, while receiving ≥ 2 consolidation cycles (HR 0.15, p < 0.001) was protective. The induction regimen was not independently significant. In older AML achieving remission, sustained consolidation and MRD-guided surveillance are pivotal, particularly in patients harboring DNMT3A or ASXL1 mutations.