BSH 2022 | The classification of AML and the role of genetic biomarkers in the management of AML
Peter Valk, PhD, Erasmus University Medical Center, Rotterdam, Netherlands, discusses the classification of acute myeloid leukemia (AML) and the role of genetic biomarkers in the management of AML. Dr Valk first explains that the current classification of AML is based on the 2017 European LeukemiaNet (ELN) risk stratification system, and briefly discusses the three categories that AML patients are divided into based on the presence of cytogenetic and molecular aberrations. Dr Valk then gives a brief overview of the treatment approaches in the HOVON clinical trials, and further discusses the ongoing revision of the ELN risk stratification system. Following this, Dr Valk mentions some of the biomarkers which will be updated in the revised version of the ELN risk stratification system, including C/EBPα and TP53 mutations. To conclude, Dr Valk explains the importance of considering mutations found in secondary leukemias when managing and treating AML. This interview took place at the 62nd Annual Scientific Meeting of the British Society for Haematology (BSH) 2022, in Manchester, UK.
Transcript (edited for clarity)
The role of biomarkers is quite diverse. During the BSH, I will talk about the markers present at diagnosis and also minimal residual disease as a biomarker. Currently, the classification of AML is purely based on molecular features of the acute myeloid leukemia. And they have been summarized in the ELN 2017 risk stratification, which is a combination of cytogenetic and molecular aberrations that classify patients in three risk categories...
The role of biomarkers is quite diverse. During the BSH, I will talk about the markers present at diagnosis and also minimal residual disease as a biomarker. Currently, the classification of AML is purely based on molecular features of the acute myeloid leukemia. And they have been summarized in the ELN 2017 risk stratification, which is a combination of cytogenetic and molecular aberrations that classify patients in three risk categories. So a favorable, an intermediate, and an adverse risk category. And whereas at least in the HOVON clinical trials, the patients in the favorable group will receive either chemotherapy or autologous transplantation. The patients that carry adverse biomarkers, and again, purely molecular, will receive a transplant. So they are treated more intensively. And what I will try to highlight actually is that the ELN risk stratification is currently being updated.
So the current markers are being reviewed and there are some novel features that we may also want to see in this revised version of the ELN recommendations. And those are CEBP alpha, mutations in CEBP alpha, which are included in the ELN 2017 currently, already. But there is some data that shows that not the double mutations, but maybe the bZIP type of mutations in CEBP alpha may be a favorable prognostic marker. And on the other hand, TP53 mutations have been shown also by us to be a very important marker with a very adverse clinical impact on patients carrying these mutations. So maybe we should treat those patients as a separate group or separate entity, and there’s data around that shows that we may want to include those mutations that are often found in secondary leukemias. And we call those secondary type leukemias or secondary like mutations that also generally have a poor impact, but those are all to be included in the revised version of the ELN recommendations.
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