Acute myeloid leukemia: 2019 update on risk‐stratification and management

Abstract

Outcome in patients with acute myeloid leukemia (AML) ranges from death within a few days of beginning treatment (treatment related mortality, TRM) to likely cure. The major reason patients are not cured is resistance to treatment, often manifested as relapse from remission, rather than, even in older patients, TRM, whose incidence is decreasing. Knowledge of the pre‐treatment mutation status of various genes has improved our ability to assign initial treatment and, of particular importance, knowledge of whether patients ostensibly in remission have measurable residual disease should influence subsequent management. Several new drugs have been approved by the FDA and we discuss their role in treatment.

Cytokine rs361525, rs1800750, rs1800629, rs1800896, rs1800872, rs1800795, rs1800470, and rs2430561 SNPs in relation with prognostic factors in acute myeloid leukemia

“…However, the robustness of this study is represented by the fact that it investigated a representative AML cohort in Romania, since, to our knowledge, there is currently no published data on the role of these polymorphisms in AML on Eastern European populations. This is the first study to investigate the association between cytokine SNPs and AML risk, and, as a result, our report presents novel observations not previously described in a complex heterogeneous disease characterized by genomic changes and the accumulation of blasts, most commonly in the bone marrow, resulting in bone marrow failure and leading to death …”

“…This is the first study to investigate the association between cytokine SNPs and AML risk, and, as a result, our report presents novel observations not previously described in a complex heterogeneous disease characterized by genomic changes and the accumulation of blasts, most commonly in the bone marrow, resulting in bone marrow failure and leading to death. 38,39 Furthermore, our study investigated, for the first time, the relationship between somatic mutations in AML and cytokine SNPs in a single multivariate model, in which the estimation method allowed the selection of variables, model fitting, and stable regression coefficients.…”

How we use venetoclax with hypomethylating agents for the treatment of newly diagnosed patients with acute myeloid leukemia

“…Outcomes are poor for patients 60 years and older who do not receive stem cell transplantation, with only 2.4% remaining alive and disease-free 10 years after diagnosis [2]. These poor outcomes are due to patient-related factors, such as increased comorbidities [3], and disease-related factors, particularly the higher incidence of adverse-risk cytogenetic abnormalities in older AML patients [4]. Lower-intensity therapies, including the hypomethylating agents (HMA) azacitidine and decitabine, have been the mainstay of therapy for older AML patients who are poor candidates for intensive induction chemotherapy.…”

Ex-vivo drug testing predicts chemosensitivity in acute myeloid leukemia

“…For example, Estey et al. proposed that the 2017 ELN intermediate and adverse patient should be considered for clinical trials or obtain a combination of 7+3+venetoclax 32 . While our findings are preliminary and need to be validated in external cohorts, our results show that the PharmaFlow test can predict patient's sensitivity to chemotherapy and may also be valuable for selecting a personalized treatment regimen.…”