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Understanding and diagnosing the specific subtypes of sAML can impact the treatment decision

Proper identification is critical in sAML

To help identify sAML following antecedent myelodysplastic syndromes (MDS) or other blood disorders, such as myeloproliferative neoplasms (MPN), or sAML that results from prior treatment with cytotoxic therapy or radiotherapy (t-AML), CAP and ASH recommend obtaining a thorough patient history and relevant clinical data1

Most AML-MRC patients DO NOT present with a documented history of MDS or MDS/MPN2

With the incidence of sAML on the rise, the percentage of patients presenting without a documented history of a hematological disorder could increase3

78% present without antecedent hematological disorder

Without antecedent hematological disorder2

22% present with an antecedent hematological disorder

With antecedent hematological disorder2

Diagnosing AML-MRC requires a closer look

Considerations for diagnosing AML‑MRC based on National Comprehensive Cancer Network® (NCCN®) recommendations and the CAP and ASH guideline1,4

Consider ordering the following tests:

  • Cytogenetic analysis (karyotype and FISH), flow cytometric immunophenotyping, and molecular genetic testing to help identify whether the patient has any relevant genetic abnormalities1,4
  • Mutational analysis for NPM1, CEBPA, and RUNX1 for patients who do not have confirmed CBF‑AML, APL, or AML‑MRC1
  • Morphologic assessment of fresh bone marrow aspirate and evaluation of bone marrow trephine core biopsy, bone marrow touch preparations, and/or marrow clots1,4

One study showed that there is no impact on overall survival in older patients if treatment is not started immediately5,a

Conventional cytogenetic analysis has been the gold standard for identification of chromosomal abnormalities in AML, but results may take longer to receive than FISH testing results. One large national reference laboratory reported an average turnaround time for cytogenetics of 7 days compared to 2.5 days for FISH6

  1. Based on a retrospective analysis of patients 60 years of age or older (n=664) with confirmed AML treated at Cleveland Clinic and MD Anderson Cancer Center.5

When you order an AML panel, consider ordering an MDS panel to ensure genetic abnormalities related to sAML are identified.7 It may be beneficial to wait for test results before starting treatment for your sAML patient

NCCN makes no warranties of any kind whatsoever regarding their content, use or application and disclaims any responsibility for their application or use in any way.

AML=acute myeloid leukemia; AML-MRC=AML with myelodysplasia-related changes; APL=acute promyelocytic leukemia; ASH=American Society of Hematology; CAP=College of American Pathologists; CBF=core binding factor; FISH=fluorescent in situ hybridization; NCCN=National Comprehensive Cancer Network; sAML=secondary AML; t-AML=therapy-related AML.

References: 1. Arber DA, Borowitz MJ, Cessna M, et al. Initial diagnostic workup of acute leukemia: guideline from the College of American Pathologists and the American Society of Hematology. Arch Pathol Lab Med. 2017;141(10):1342-1393. 2. Miesner M, Haferlach C, Bacher U, et al. Multilineage dysplasia (MLD) in acute myeloid leukemia (AML) correlates with MDS-related cytogenetic abnormalities and a prior history of MDS or MDS/MPN but has no independent prognostic relevance: a comparison of 408 cases classified as “AML not otherwise specified” (AML-NOS) or “AML with myelodysplasia-related changes” (AML-MRC). Blood. 2010;116(15):2742-2751. 3. Cheung E, Perissinotti AJ, Bixby DL, et al. The leukemia strikes back: a review of pathogenesis and treatment of secondary AML. Ann Hematol. 2019;98(3):541-559. 4. Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Acute Myeloid Leukemia V.3.2019. © National Comprehensive Cancer Network, Inc. 2019. All rights reserved. Accessed May 7, 2019. To view the most recent and complete version of the guideline, go online to 5. Sekeres MA, Elson P, Kalaycio ME, et al. Time from diagnosis to treatment initiation predicts survival in younger, but not older, acute myeloid leukemia patients. Blood. 2009;113(1):28-36. 6. Hammer RD, Doll D, Layfield L, et al. Is it time for a new gold standard? FISH vs cytogenetics in AML diagnosis. Am J Clin Pathol. 2016;145(3):430-432. 7. Roloff GW, Griffiths EA. When to obtain genomic data in acute myeloid leukemia (AML) and which mutations matter. Blood Adv. 2018;2(21):3070-3080.