Dr Eisfeld on Updated Guidelines for the Classification of AML

Ann-Kathrin Eisfeld, MD, assistant professor, director, Clara D. Bloomfield Center for Leukemia Outcomes Research, Division of Hematology, member, Leukemia Research Program, The Ohio State University Comprehensive Cancer Center–James, discusses recent changes to the classification of acute myeloid leukemia (AML), and potential challenges accompanying these new guidelines.

One of the most highly discussed changes is the new classification of AML myelodysplasia-related changes (AML-MRC) in the World Health Organization classification of AML, Eisfeld begins. Prior to the updated recommendations, this biologic subtype of AML was identified through quantitative and qualitative evaluations. The tumor was required to be evaluated under a microscope to grade dysplasia, or a patient must have had a known history of, or hereditary predisposition to, myelodysplastic syndrome (MDS), Eisfeld explains.

With recent advances in the understanding of disease biology in AML, this approach is no longer required, Eisfeld states. Instead, patients may be diagnosed with AML-MRC in the absence of identifiable MDS if they display certain genetic mutations, she continues. The justification for the inclusion of this new category is that genetic changes associated with AML are heterogeneous and are often associated with poorer prognosis, Eisfeld says. However, more research still needs to be done to identify how clinicians should proceed if patients display favorable risk markers.

Ultimately, the inclusion of these genetic markers in updated classification guidelines can allow patients to be diagnosed sooner. In turn, these patients may qualify for first-line treatment options other than conventional chemotherapy, such as venetoclax (Venclexta) and CPX-351 (Vyxeos), Eisfeld concludes.