How I Treat AML in 2023 Incorporating the Updated Classifications and Guidelines

Abstract

The European LeukemiaNet (ELN) recently revised both the clinical (2022) and measurable residual disease (MRD) testing (2021) guidelines for acute myeloid leukemia (AML). Updated World Health Organization (WHO) and an International Consensus Classification (ICC) for myeloid neoplasms were also published in 2022. Together, these documents update the classification, risk stratification, prognostication, monitoring recommendations, and response assessment for patients with AML. Increased appreciation of the genetic drivers of AML over the past decade and our increasingly sophisticated understanding of AML biology have been translated into novel therapies and more complex clinical treatment guidelines. Somatic genetic abnormalities and germline predispositions now define and guide treatment and counseling for subtypes of this hematologic malignancy. In this paper, we discuss how we approach AML in daily clinical practice taking into consideration these recent updates in the context of new treatments and discoveries over the past decade.

A Markov analysis of azacitidine and venetoclax vs induction chemotherapy for medically fit patients with AML

“…Our results contribute to a growing body of literature indicating that the 2017 European Leukemia Network risk stratification is not necessarily prognostic in patients treated with a combination of hypomethylating agent and ven. 16 , 39 An area of particular interest is the efficacy of aza-ven in isocitrate dehydrogenase 1/2 (IDH1/2)-mutated AML (∼8% and ∼12% of AML cases, respectively). The prognostic implications of IDH1/2 mutations have yet to be fully elucidated, with either favorable 40 , 41 adverse, 42 , 43 , 44 or uncertain prognosis.…”

“…Disease states after induction included composite CR (CR, or CR with incomplete hematologic recovery), primary refractory disease (no CR after 2 courses of intensive induction treatment), or early death (from any cause within 30 days). 14 , 15 , 16 Those who achieved CR either did or did not receive allo-SCT, and both groups either remained in disease-free survival (DFS), transitioned to relapse, or proceeded to death (from any cause after 30 days). Patients who relapsed either transitioned to a second CR (CR2) or died.…”

Measurable Residual Disease Detection in Acute Myeloid Leukemia: Current Challenges and Future Directions

“…As outlined above, the assessment of MRD has become a crucial aspect in the management of AML providing highly valuable information on a patient’s individual risk of relapse [ 11 ]. In this section, we summarize the implications as well as the shortcomings of MRD assessment in current clinical practice.…”

“…The significance of MRD remained consistent regardless of age groups and AML subtypes [ 7 ]. Therefore, testing for MRD has emerged as a critical concept in the treatment of AML [ 11 ] (see Figure 1 ). Accordingly, current European LeukemiaNet (ELN) guidelines for AML diagnostics and therapy recommend MRD detection for all AML patients in complete remission after intensive chemotherapy to gain prognostic information on each patient’s risk of relapse [ 5 , 12 ].…”

Suppression of DNMT1 combined with ATM or ATR inhibitor as a therapeutic combination of acute myeloid leukemia

“…Most AML patients experience relapse within 12 months after treatment, but the risk of relapse decreases over time [ 2 ]. According to the European LeukemiaNet (ELN) scoring system for prognosis evaluation of relapsed young AML patients (age ≤ 60), the proportion of high-risk relapsed AML patients is 66%, with 1-year and 5-year overall survival rates of 16% and 4% respectively [ 3 ]. ELN confirmed that shorter time to relapse, adverse genetic characteristics, and older age at relapse are positively correlated with poor prognosis.…”