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What Tests Are Used to Assess AML Treatment Response?

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Published on August 15, 2019

During this Ask the Expert segment, Dr. Daniel Pollyea, from the University of Colorado School of Medicine, discusses the three crucial tests recommended for acute myeloid leukemia (AML) patients at diagnosis that help identify disease risk factors and guide treatment decisions. Dr. Pollyea also explains the value of minimal residual disease (MRD) testing and how it’s used to evaluate a patient’s response to therapy. Watch now to learn about AML flow cytometry tests and more.

This program is sponsored by AbbVie, Inc and Genentech, Inc. It is produced by Patient Power in partnership with The Leukemia & Lymphoma Society (LLS) and NeedyMeds. These organizations have no editorial control, and Patient Power is solely responsible for program content.

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Transcript | What Tests Are Used to Assess AML Treatment Response?

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.

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:          

I wanna ask you about testing. You mentioned it earlier about how crucial it is, genomic testing at the beginning to find out what is your version of AML that you're dealing with, and then retesting along the way. So, I would imagine if somebody come out of remission, what are you dealing with then. But what tests are done, and I know in some fields of blood cancer, you do minimal residual disease testing, so what is a remission look like, and how do you know?

Dr. Pollyea:                 

Yeah. Okay, good. So, at the time of diagnosis, there are a couple of things that happened all of which pretty much have to happen off of that original bone marrow plasty. One, we have to get just some cells from the bone marrow that we can look at under a microscope and just look to see how many immature cells. That's number one, that's what we call morphology. That just means, what do the cells look like. Two, we do a fancy test called flow cytometry where we put the cells from the bone marrow through a special instrument, and it can tell us, and count for us how many really immature cells are there. 

That is also a test to confirm is this acute myeloid leukemia; is this acute lymphoblastic leukemia because those can look the same; is this another disease? So, that's a really important test, as well. Three, we look at the chromosomes. The chromosomes are the, sort of, houses of all of the genes, all the genetic material in each cell. Every cell in its nucleus has 23 chromosomes, two copies of 23 chromosomes, and we have learned over decades of working with AML about 50 percent of patients will have abnormalities in the chromosomes of their disease cell. 

Sometimes there's a chromosome missing. Sometimes there's an extra copy of a chromosome. Sometimes two chromosomes have fused together. All of that is crucial information because what we've learned over the years is that some of those chromosomal abnormalities are associated with better than average outcomes; some of those chromosomes are associated with worse than average outcomes. So, that I a crucial piece of information. 

The newest test that we do that is crucial, again, at the time diagnosis is genomic testing. Sometimes we call it next generation sequencing, or there's a couple different phrases for it. This is where we have the opportunity to look at about 50 different genes that may be mutated in a person's disease. And we need to know which 2, 3, 5, 10, whatever, genes each person has mutated in their disease because that is prognostic, it helps us understand how a person might do, how aggressive their disease may be, and it's also important for treatment decision making because now we have several treatments that are only applicable if you have a certain gene mutation associated with your disease. 

So, that's all what we do at the time diagnosis, very important to get every single one of those tests. At the time of remission, so hopefully a person goes into a remission, that means when we look under the microscope, we don’t see any leukemia cells, and it also technically means that the normal blood cells have recovered. The normal blood counts, not meaning transfusion. That's a remission. But what we know is if we peek a little bit deeper, under the surface, we might still see some residual disease.

And there are a couple different ways to look for residual disease. One is by looking for those chromosomal abnormalities, so that was an opportunity to compare, do we still see the chromosome abnormalities that we might have detected at the time diagnosis? The second is to look for evidence of gene mutations. Are they still present, and if they are, at what level?

So, those are what we call MRD, or minimal residual disease. Of course, it’s in remission, bone marrow looks great under a microscope, cell counts have removed, they're not needing transfusion, they feel fine. But getting a sense of how deep the remission is and how mush disease might still be present at a super low level is important because if it's still present, then that is a potential population that could relapse. And so, there's ways now that we might want to treat that residual disease population. 

Or maybe that helps us make a decision. If you still have some residual disease, maybe you should go and get a transplant because that might be the only way that you can be cured. Alternatively, maybe you don’t have any residual disease that we can detect at any level. Maybe we should just back off and watch you closely because maybe you’ve been cured. So, that's how the minimal residual disease helps us. 

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.