Treatment Overview for Acute Myeloid Leukemia
Risk classification systems under clinical evaluation
While the optimal manner in which to utilize MRD to risk stratify treatment has not been determined, the next COG trial for newly diagnosed patients with AML will use the combination of MRD status as well as cytogenetic and molecular information to risk stratify patients into two groups. Thus, the low-risk AML group will include mutations involving CBF, CEBPA, NPM, and those with no MRD at end of induction therapy; this group of patients represents about 73% of patients and has a predicted OS of approximately 75%. In contrast, the high-risk AML group represents the remaining 27% of patients and has a predicted OS less than 35%; this group includes patients with adverse cytogenetic abnormalities, such as monosomy 7, del(5q)-, -5, high FLT3-ITD to wild-type allelic ratio, or MRD at the end of induction. 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.
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