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ASH 2024 | The WHO’s 5th classification for AML: expanding the number of genetically defined categories

Sanam Loghavi, MD, The University of Texas MD Anderson Cancer Center, Houston, TX, provides insight into the 5th iteration of the World Health Organization’s (WHO) classification for acute myeloid leukemia (AML), highlighting the shift from a blast numerical cutoff to genomic classification. This has resulted in an expansion of the number of genetically defined categories of AML to approximately 20, with only two subtypes (AML with CEBPA mutation or BCR-ABL translocation) still requiring a blast count of 20%. This interview took place at the 66th ASH Annual Meeting and Exposition, held in San Diego, CA.

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Transcript (AI-generated)

The fifth iteration of the WHO has really completely revamped the classification of acute myeloid leukemia with really heavy emphasis and focus on genomic classification of AML rather than using a blast numerical cutoff. So the genetically defined categories of AML have expanded. There are now, you know, like NPM1 mutated AML used to be a provisional category. It is now considered a bona fide category of AML...

The fifth iteration of the WHO has really completely revamped the classification of acute myeloid leukemia with really heavy emphasis and focus on genomic classification of AML rather than using a blast numerical cutoff. So the genetically defined categories of AML have expanded. There are now, you know, like NPM1 mutated AML used to be a provisional category. It is now considered a bona fide category of AML. There are other subtypes, like NUP98-rearranged AML, that has been added to the classification. There are other subtypes where the blast count requirement has been removed, such as AML with KMT2A rearrangement or AML with MECOM rearrangement. You know, the list goes on and on. We have about 20 something genetically defined categories of AML. Really the only ones that still require a blast count of 20% in the WHO category are AML with CEBPA mutation and AML with BCR-ABL translocation, obviously because of the overlap with CML because we don’t want to be over calling myeloid blast phase of CML as AML.

 

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Disclosures

Syndx, Servier, BMS: Membership on an entity’s Board of Directors or advisory committees; Astellas, Amgen: Research Funding; Abbvie: Current holder of stock options in a privately-held company; Guidepoint; QualWorld; Gerson Lehrman Group, AlphaSight, Arima, Qiagen, Opinion Health: Consultancy; Abbvie, Daiichi Sankyo, BluePrint Medicine, Caris Diagnostics, Recordati, Servier: Consultancy; Pathology Education Partners; VJ HemeOnc, College of American Pathologists, OncLive, ICCS, MD Education, NCCN, MashUp Media, NCTN, Aptitude Health: Honoraria.