hematology and oncology
Acute Myeloid Leukemia (AML)
Prognosis for AML
Remission induction rate ranges from 50 to 85% ( Prognosis reference ). Long-term disease-free survival is about 20 to 40% overall but is 40 to 50% in younger patients treated with intensive chemotherapy or stem cell transplantation. Prognostic factors help determine treatment protocol and intensity; patients with strongly negative prognostic features are usually given intense forms of therapy followed by allogeneic stem cell transplantation. In these patients, the potential benefits of intense therapy are thought to justify the increased treatment toxicity. Theleukemia cell karyotypeis the strongest predictor of clinical outcome. Based on the specific chromosomal rearrangements, three clinical groups have been identified: favorable, intermediate, and poor (see table). Molecular genetic abnormalitiesare also important in refining prognosis and therapy in AML. Many different mutations exist; these are categorized into groups based on their effect on prognosis and treatment. Patients with AML average 5 recurrent gene mutations. Patients with mutations inNPM1, or inCEBPAhave a more favorable prognosis. Mutations inFLT3, on the other hand, have a poorer prognosis (including in patients who also have an otherwise favorableNPM1mutation). Other factors that suggest a poorer prognosis include a Preceding Myelodysplastic Syndrome (MDS) None Therapy-related AML High WBC count (> about 50,000/microL [> 50×109/L]) Patient-specific adverse prognostic factors include age ≥ 65, poor performance status, and comorbidities. Older patients are more likely to have high-risk cytogenetic abnormalities (see table Prognosis of Acute Myeloid Leukemia Based on Some Common Cytogenetic Abnormalities ), secondary AML, and AML that is resistant to multiple drugs. Minimal residual disease is defined as having < 0.1 to 0.01% (based on the assay used) leukemic cells in bone marrow. In AML, minimal residual disease can be assessed by multiparameter flow cytometry detection of leukemia-associated immunophenotype or by mutation-specific polymerase chain reaction (PCR). These tools are prognostically accurate but are not quite ready for routine use in clinical practice. 1.Döhner H, Wei AH, Appelbaum FR, et al. Diagnosis and management of AML in adults: 2022 recommendations from an international expert panel on behalf of the ELN.Blood2022;140(12):1345-1377. doi:10.1182/blood.2022016867 