The genomics of acute myeloid leukemia in children

Abstract

Acute myeloid leukemia (AML) is a clinically, morphologically, and genetically heterogeneous disorder. Like many malignancies, the genomic landscape of pediatric AML has been mapped recently through sequencing of large cohorts of patients. Much has been learned about the biology of AML through studies of specific recurrent genetic lesions. Further, genetic lesions have been linked to specific clinical features, response to therapy, and outcome, leading to improvements in risk stratification. Lastly, targeted therapeutic approaches have been developed for the treatment of specific genetic lesions, some of which are already having a positive impact on outcomes. While the advances made based on the discoveries of sequencing studies are significant, much work is left. The biologic, clinical, and prognostic impact of a number of genetic lesions, including several seemingly unique to pediatric patients, remains undefined. While targeted approaches are being explored, for most, the efficacy and tolerability when incorporated into standard therapy is yet to be determined. Furthermore, the challenge of how to study small subpopulations with rare genetic lesions in an already rare disease will have to be considered. In all, while questions and challenges remain, precisely defining the genomic landscape of AML, holds great promise for ultimately leading to improved outcomes for affected patients.

Keywords: Acute myeloid leukemia; Genomics; Pediatric; Risk stratification; Targeted therapies.

Fig. 1

Leukemic fusions in acute myeloid leukemia by age. The approximate frequency of recurrent fusions in AML in infants (defined as patients < 2 years of age), young children (2–14 years), adolescents and young adults, (AYA; 15–39 years), and adults (≥ 40 years). NK, normal karyotype. (compiled data from Creutzig et al. [5] and Bolouri et al. [32])