NPM1 Measurable Residual Disease: A Narrative Review

Abstract

Acute myeloid leukemia (AML) with mutated NPM1 (Nucleophosmin 1) is a distinct entity in the 5th edition of the World Health Organization (WHO) Classification as well as a favourable risk category in the 2022 European LeukemiaNet (ELN) Recommendations for AML. The development of myriad techniques for detection of NPM1 Measurable Residual Disease (MRD) has led to improved patient outcomes; however, there is no one winner. Each modality has its own nuances and caveats, and hence using a synoptic and integrated approach is recommended to avoid potential false negatives. Therapy guided by genomic MRD especially in decision for timing of transplant has been reported in literature, which has shown benefits of regular longitudinal monitoring of NPM1. This is a narrative review which discusses in detail the testing modalities for NPM1 MRD in AML. Keywords like 'NPM1", "MRD", "NGS", were searched in Pubmed, Embase and Scopus and a total of 40 articles were included. Since this is not a systematic review or meta-analysis no inclusion or exclusion criteria were laid and no formal statistics was done. This article was constructed in pursuit of raising awareness for this unmet need, as well as to amalgamate all old and new knowledge in this space. The future is artificial intelligence and machine learning which may pave the way for risk scores.

Supplementary information: The online version contains supplementary material available at 10.1007/s12288-025-01958-4.

Keywords: AML; Blasts; MDS; NPM1.