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What Do Mutations Indicate About AML Prognosis?

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Published on December 19, 2019

Key Takeaways

  • AML is a heterogeneous condition.
  • Each person’s AML treatment is individualized based on their diagnosis.
  • There is no longer just one standard treatment for AML.

What is an acute myeloid leukemia (AML) subtype? How does mutational status impact care decisions? Leading experts Dr. Pinkal Desai and Dr. Tapan Kadia discuss the heterogeneity of AML, and the importance of understanding your “version” of the disease to find the most effective treatment. Watch as the AML experts explain which tests are recommended at diagnosis to help determine each patient’s course of therapy.

This is a Patient Empowerment Network program produced by Patient Power. We thank Astellas, Celgene Corporation, Daiichi Sankyo and Jazz Pharmaceuticals for their support. These organizations have no editorial control. Patient Power is solely responsible for program content.

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Transcript | What Do Mutations Indicate About AML Prognosis?

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Andrew Schorr:                       

Not everyone’s AML is the same, right? We’re talking about almost a constellation of versions of AML, and medicines being developed for different subtypes, right?

Dr. Kadia:                      

Absolutely. I think what you say is spot on. I think more and more over the past couple of decades, we’ve realized that AML is very heterogeneous, not only from the type of patients we see, but among them, the type of leukemias we see. So, you can divide them in many different ways. People have divided them by age, people have divided them based on prior malignancies, prior neoplasms that occur, private development in MDS like myelodysplastic syndrome prior to AML.

And then, we talk about things like cytogenetics, which are the chromosome abnormalities which happen in AML, which help distinguish whether the AML’s going to be a little bit more favorable an outcome, or whether there are going to be difficulties in getting in remission, whether the patient will require a transplant. We also do—now, the next level of heterogeneity is mutation testing. What that is is we actually will sequence the DNA of the leukemia cells.

Over the past few years, we’ve recognized that there are recurring mutations or small abnormalities within the DNA that actually have an impact, not only on the prognosis, but they can predict the response of different types of therapies. This is a whole new era where we’re really looking at different individualized AMLs in different ways, and treating them in those respective ways. We’ve realized that these genetic abnormalities not only give us an idea of the prognosis, but also the treatment course in how these patients do. So, it’s important when patients come in to really characterize this heterogeneity, identify what they’re going to respond to, and then base the therapy on what you find.

Andrew Schorr:                       

So, in other words, what version of AML are you dealing with?

Dr. Kadia:                      

Absolutely. We talked—a few minutes ago, Dr. Desai talked about the rapidity with which we treat. Right off the bat, you can see there are patients who are older with AML and younger patients with AML. It’s a very simple way of dividing it, but many older patients with AML typically have a pre-existing condition, such as myelodysplastic syndrome, which may have gone unrecognized for months or years with some low blood counts, and then they present with low blood counts. Those patients tend to have white counts in the low range – lower than normal—and typically, you watch them for a couple of days, three days, as an outpatient.

Then, you may have de novo AML in a younger patient who has a different phenotype, or much more proliferative across the phenotype, where you need to get them in the hospital, get that white count down, make sure they’re not having organ infiltration, and start the process there. There are many different ways of looking at the heterogeneity of AML, but “different versions” is right. You really need to figure out what you have.

Andrew Schorr:                       

So, Dr. Desai, when someone is referred to you now, is this genomic testing usually part of the workup, if you will, to say, “What are we dealing with here?”

Dr. Desai:                      

Absolutely. I feel like nowadays, with the kind of leukemia treatments and drugs available, not just—like we were saying, that it’s not just about predicting who’s going to do well and whether transplant is a possibility or not, the up-front treatments are dramatically different depending on whatever the genomic profile for that patient is.

So, as soon as the patient comes in—and, that’s why my point is that you have to get the concept started right away—you have to send the right—do a bone marrow biopsy, or sometimes off pair for blood, send the mutational testing and this unit genomic profiling, because that dictates the up-front management completely these days, unlike the old times, where everybody got treated with just one treatment. That is no longer the case. So, that is absolutely a necessity to do.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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