Diagnosis and management of AML in adults: 2017 ELN recommendations from an international expert panel

Abstract

The first edition of the European LeukemiaNet (ELN) recommendations for diagnosis and management of acute myeloid leukemia (AML) in adults, published in 2010, has found broad acceptance by physicians and investigators caring for patients with AML. Recent advances, for example, in the discovery of the genomic landscape of the disease, in the development of assays for genetic testing and for detecting minimal residual disease (MRD), as well as in the development of novel antileukemic agents, prompted an international panel to provide updated evidence- and expert opinion-based recommendations. The recommendations include a revised version of the ELN genetic categories, a proposal for a response category based on MRD status, and criteria for progressive disease.

Figure 1.

Molecular classes of AML and concurrent gene mutations in adult patients up to the age of ∼65 years. Class definition is based on the study by Papaemmanuil et al. For each AML class denoted in the pie chart, frequent co-occurring mutations are shown in the respective boxes. Data on the frequency of genetic lesions are compiled from the databases of the British Medical Research Council (MRC), the German-Austrian AML Study Group (AMLSG), and from selected studies.^{,,, a} indicates cohesin genes including RAD21 (∼10%), SMC1A (∼5%), and SMC3 (∼5%); ^b, inv(16)(p13.1q22) or t(16;16)(p13.1;q22); CBFB-MYH11; ^c, inv(3)(q21.3q26.2) or t(3;3)(q21.3;q26.2); GATA2,MECOM(EVI1); and ^d, TP53 mutations are found in ∼45%, and complex karyotypes in ∼70% of this class. The structure of the pie chart is adapted from Grimwade et al, generated by Adam Ivey (King’s College London, London, United Kingdom).