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ISAL 2025 | Stratifying secondary AML: the importance of genomics and blast counts
Maria Teresa Voso, MD, University Tor Vergata, Rome, Italy, comments on the classification of secondary acute myeloid leukemia (AML). Dr Voso emphasizes that secondary AML is now considered a diagnostic qualifier due to its genetic basis, and she highlights the importance of blast counts in stratifying patients. This interview took place at the 19th International Symposium on Acute Leukemias (ISAL XIX) in Munich, Germany.
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Transcript
Well, according to the new classifications of AML, secondary AML is really a diagnostic qualifier since, as I mentioned before, the definition of AML is mostly genetically based. Having a disease whose evolving from a previous MDS or MDS-MPN or following cytotoxic treatment for a primary cancer or even in the context of a germline predisposition is now considered a diagnostic qualifier...
Well, according to the new classifications of AML, secondary AML is really a diagnostic qualifier since, as I mentioned before, the definition of AML is mostly genetically based. Having a disease whose evolving from a previous MDS or MDS-MPN or following cytotoxic treatment for a primary cancer or even in the context of a germline predisposition is now considered a diagnostic qualifier. And since the disease, the definition of the disease is mostly genetically based, a therapy-related AML should be classified according to the genetics, to the specific genetics. For instance, a therapy-related APL should be treated as de novo APL. And indeed, when we stratify the patients according to therapy-related AML, according to ELN 2022, we see that there is a very nice distribution of the three subgroups according to genetics. Also, survival differences when grouping patients according to genetics. On the other hand, when we do the same with myelodysplasia-related AML, including those who are secondary to a previous MDS or MDS-MPN, and the stratification does not work that well because most of patients are in the adverse risk group. And there is another category which is also calling for attention, which is the MDS-AML category, which is defined by patients who have 10% to 19% blasts as opposed to overt AML where we have over 20% blasts. And when we look at these patients and compare it to patients with over 20% blasts, we see that there are differences from a genomic point of view. And this is the object of our poster here, showing that there are mutations such as FLT3 and NPM1, which are more typical of AML with over 20% blasts, while the MDS-AML still have profiles which are more similar or recall MDS. So we think that the blast counts are still important when we are classifying and stratifying patients. And at least these are the results of our analysis on several hundreds of patients.
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