Case Reports in Surgery and Invasive Procedures

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Biologic heterogeneity of AML: Implications for prognosis and treatment

Joint Event on International Conference on Plastic and Cosmetic Surgery & International Conference on Biomarkers
March 11-12, 2019 | London, UK

Clara D Bloomfield

The Ohio State University Comprehensive Cancer Center, USA

Posters & Accepted Abstracts : Case Rep Surg Invasive Proced

Abstract:

Adult 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-ITDlow), and biallelic mutated CEBPA. The Intermediate category includes mutated NPM1 and FLT3-ITDhigh, wild-type NPM1 without FLT3-ITD or with FLT3-ITDlow, 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-ITDhigh, 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.

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