Treatment Overview for Acute Myeloid Leukemia (AML)
Risk classification systems under clinical evaluation
Risk classification for treatment assignment on the COG-AAML1031 study is based on cytogenetics, molecular markers, and MRD postinduction I, with patients being divided into a low-risk or high-risk group as follows:
The low-risk group represents about 73% of patients, has a predicted OS of approximately 75%, and is defined by the following:
- Inv(16), t(8;21), nucleophosmin (NPM) mutations, or CEBPA mutations with any MRD status.
- Standard-risk cytogenetics with negative MRD at end of Induction I.
The high-risk group represents the remaining 27% of patients, has a predicted OS less than 35%, and is defined by the following:
- High allelic ratio FLT3/ITD+ with any MRD status.
- Monosomy 7 with any MRD status.
- del(5q) with any MRD status.
- Standard-risk cytogenetics with positive MRD at end of Induction I.
The high-risk group of patients will be offered transplantation in first remission with the most appropriate available donor. Patients in the low-risk group will only be offered transplantation in second complete remission.[52,53]
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