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Case Reports in Surgery and Invasive Procedures | Volume 3
March 11-12, 2019 | London, UK
Biomarkers
Plastic and Cosmetic Surgery
International Conference on
International Conference on
Joint Event
&
Biologic heterogeneity of AML: Implications for prognosis and treatment
Clara D Bloomfield
The Ohio State University Comprehensive Cancer Center, USA
A
dult acute myeloid leukemia (AML) was essentially
incurable 50 years ago. Today 35-40% <60 years old and
5-15% ≥60 are cured. AML is a biologically heterogeneous
disease significantly impacting prognosis and treatment.
Most important for selecting therapy are cytogenetics and
molecular genetics. Both are incorporated into the current
AML World Health Organization (WHO) and European
LeukemiaNet (ELN) classifications. Therapies are being
developed that target the genetic aberrations.
In the 2016/2017 WHO AML classification AML with
NPM1
mutations and AML with biallelic CEBPA mutations are
definite entities and AML with
BCR-ABL1
and AML with
mutated
RUNX1
are provisional entities. The other major
change is the addition of “myeloid neoplasms with germline
predisposition”.
The 2017 ELN divides AML into three risk categories. The
Favorable category includes AML with t(8;21)(q22;q22),
inv(16)(p13.1q22), mutated
NPM1
without
FLT3-ITD
or with
FLT3-ITD
with a low allelic ratio
(FLT3-ITD
low
)
, and biallelic
mutated
CEBPA
. The Intermediate category includes mutated
NPM1 and
FLT3-ITD
high
, wild-type
NPM1
without FLT3-ITD
or with
FLT3-ITD
low
, t(9;11)(p21.3;q23.3) and cytogenetic
abnormalities not favorable or adverse. The Adverse
category includes AML with t(6;9)(p23;q34.1), t(v;11q23),
t(9;22)(q34.1;q11.2), inv(3)(q21.3q26.2)/t(3;3)(q21.3;q26.2),
-5/del(5q)/-7/-17/abn(17p), complex karyotype (≥3) or
monosomal karyotype, wild-type
NPM1
and
FLT3-ITD
high
,
mutated
RUNX1
, mutated
ASXL1
and mutated
TP53
.
Additional genes allow more precise classification of ELN
genetic groups/subsets. Molecular understanding of AML
is rapidly increasing. This is resulting in subgroups with
apparent cure rates of >80% of younger and >40% of older
patients without allogeneic transplantation in first complete
remission, new predictors for treatment response and new
targeted therapies.
e:
Clara.Bloomfield@osumc.edu