sAML RISK FACTORS

Video Duration: 2:37

((Dr. Jonathan Abbas))

I’m Dr. Jonathan Abbas, the director of the acute leukemia and blood cancer program with Tennessee Oncology in Nashville, Tennessee. I’ve been treating patients with blood cancers, specifically acute leukemia, for over a decade, and my center does over a 100 inductions a year in patients with AML, many of them with therapy-related AML and AML-MRC.

In my opinion, patients with therapy-related AML and AML-MRC represent amongst the most high-risk patients we treat. Often, these patients are already on active therapy for their MDS or MDS/MPN, and therefore, when they do progress on therapy, they often have very high blast percentages and very high risk cytogenetic and molecular features. It is all of these sort of variables, which make these amongst the most high-risk patients we treat and, unfortunately, that is what is associated with such poor outcomes.

It is important for patients with MDS to be proactively and routinely monitored for progression to secondary AML.

Clinical workups to consider include:

Peripheral blood counts and bone marrow analysis for morphologic changes that suggest progression to AML-MRC
Flow cytometry, which can identify dyspoiesis that may correlate with clinical outcomes and genetic abnormalities
Genetic sequencing, such as PCR and NGS, to monitor for gene mutations

In addition, a referral to a hematologist specializing in leukemia care and/or a bone marrow transplant specialist should occur early, so an appropriate treatment plan is in place in case the MDS does progress to AML-MRC.

In my experience, this is one of the most common consults I receive from my hematology colleagues. Very often, patients with low-risk or intermediate-risk MDS have not always received thorough cytogenetic and molecular workups. This allows us to sometimes identify patients who might actually have a more aggressive and higher-risk disease than initially appreciated. This allows me to not only potentially initiate treatment sooner, but also to make appropriate referrals to stem cell transplant centers.