Management of patients with cytogenetically normal acute myeloid leukemia who have neither favorable nor unfavorable markers.
The presence or absence of cytogenetic and molecular abnormalities present at the time of diagnosis of acute myeloid leukemia (AML) not only provides important prognostic information, but also directs decisions regarding postremission therapy. In no other group has molecular analysis been more important than for the 40% to 50% of newly diagnosed patients in whom clonal chromosomal aberrations are not detected. Patients with cytogenetically normal (CN) AML were once considered a homogenous group, but are now classified into molecularly defined subgroups with distinct clinical outcomes. Evaluating FLT3, NPM1, and CEBPA mutational status is a routine component of the diagnostic evaluation for all patients with CN-AML and is used to determine outcome risk. However, in patients with FLT3 wild-type/NPM1 wild-type/CEBPA wild-type CN-AML, the optimal postremission therapy has not been well defined. This article reviews treatment outcomes for this group of patients after chemotherapy and autologous and allogeneic stem cell transplantation. New recurrent somatic mutations and their prognostic significance in patients with FLT3 wild-type/NPM1 wild-type CN-AML are also addressed.
From the aDivision of Hematology, Department of Internal Medicine, and bDepartment of Molecular, Cellular, and Developmental Biology, The Ohio State University and The Ohio State Comprehensive Cancer Center, Columbus, Ohio.
Alison R
AR
Walker
Guido
G
Marcucci
D003582:Cytogenetics; D004252:DNA Mutational Analysis; D020869:Gene Expression Profiling; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000145:classification* / Q000188:drug therapy* / Q000235:genetics*; D009154:Mutation; D000090243:Nucleophosmin