Molecular therapy for acute myeloid leukaemia

Abstract

Acute myeloid leukaemia (AML) is a heterogeneous disease that is, in general, associated with a very poor prognosis. Multiple cytogenetic and molecular abnormalities that characterize different forms of AML have been used to better prognosticate patients and inform treatment decisions. Indeed, risk status in patients with this disease has classically been based on cytogenetic findings; however, additional molecular characteristics have been shown to inform risk assessment, including FLT3, NPM1, KIT, and CEBPA mutation status. Advances in sequencing technology have led to the discovery of novel somatic mutations in tissue samples from patients with AML, providing deeper insight into the mutational landscape of the disease. The majority of patients with AML (>97%) are found to have a clonal somatic abnormality on mutational profiling. Nevertheless, our understanding of the utility of mutation profiling in clinical practice remains incomplete and is continually evolving, and evidence-based approaches to application of these data are needed. In this Review, we discuss the evidence-base for integrating mutational data into treatment decisions for patients with AML, and propose novel therapeutic algorithms in the era of molecular medicine.

Figure 1. Proposed treatment algorithm for patients aged >60 years with newly diagnosed AML

All novel agents, both targeted and ‘non-targeted’, should be administered in the setting of a clinical trial. HDAC, histone deacetylase; LDAC, low‑dose cytarabine.

Figure 2. Proposed treatment algorithm for patients aged ≤60 years with newly diagnosed AML

All novel agents, both targeted and ‘non‑targeted’, should be administered in the setting of a clinical trial. CR, complete response; HDAC, histone deacetylase.