ISAL 2023 | Comparing the ICC and WHO classifications for secondary AML and their impact on clinical practice
In this video, Enrico Attardi, MD, University of Rome Tor Vergata, Rome, Italy, shares some insights into the two classifications used for the diagnosis of secondary acute myeloid leukemia (sAML): the International Consensus Classification (ICC) and the World Health Organization (WHO). Dr Attardi then compares these two classification systems, highlighting differences in how they define sAML and various sub-entities of AML. This interview took place at the 18th International Symposium on Acute Leukemias (ISAL XVIII), held in Munich, Germany.
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Transcript (edited for clarity)
So secondary AML includes therapy-related AML, but also AML with an antecedent hematological disorder. So in the last year we had two diagnostic classifications that are the 2022 WHO diagnostic classification, but also the International Consensus Classification. And they both explain in a different way the concept of the secondary AML because regarding the WHO 2022, we have a newly segregated entity in which we can have secondary myeloid neoplasm post cytotoxic therapy, for example, post chemotherapy, but also post therapy with PARP inhibitor...
So secondary AML includes therapy-related AML, but also AML with an antecedent hematological disorder. So in the last year we had two diagnostic classifications that are the 2022 WHO diagnostic classification, but also the International Consensus Classification. And they both explain in a different way the concept of the secondary AML because regarding the WHO 2022, we have a newly segregated entity in which we can have secondary myeloid neoplasm post cytotoxic therapy, for example, post chemotherapy, but also post therapy with PARP inhibitor. But we also have secondary myeloid neoplasms and so also secondary AML to germline predisposition with that list of genes that we expected to see increased over time. On the other side, the ICC defined secondary AML as a diagnostic qualifier that are therapy-related AML, AML with germline predisposition or also AML with an antecedent MDS or MDS/MPN. If we want to extend this concept of the secondary AML, we could also have some differences regarding the previous diagnostic categories that are the AML-MRC, myelodysplasia-related changes, in particular in their inclusion criteria for example the dysplasia that is eliminated but also the antecedent MDS diagnosis is also described in the 2022 WHO classification. And on the other side, we should have different sub-diagnostic categories in both 2022 classification and in the ICC. In the ICC we have three different sub-entities that are the TP53 AML subcategory, the AML with myelodysplasia-related gene mutation and AML with cytogenetic abnormalities. On the other hand, the WHO 2022 also have a new unique entity that is the myelodysplasia-related with both cytogenetic abnormalities but also the new MDS related gene mutation. And the most important difference is related to RUNX1 mutation that is present in the ICC. But we also have some minor points concerning the cytogenetic abnormalities. So it is essential in order to have a proper diagnosis of secondary AML to catch these differences among the two different diagnostic classifications.
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