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Which gene mutations are categorized as low, intermediate and high risk AML?
Posted by
HealthTree • April 3, 2023
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Which gene mutations are categorized as low, intermediate, and high-risk AML? What is clonal evolution in AML? There are some low-risk AML categories. Those low-risk AML categories are fairly sparse. So one is if you have a translocation between chromosome 15 and 17 in a gene called PML and RAR, there's really a different flavor of leukemia altogether called acute promyelocytic leukemia. It is a completely different way that it's treated, but it's an important piece of information to ensure whether or not it's present. The second is a cytogenetic abnormality where chromosome 16 has two parts of it broken and the middle part flips around called an inversion. There's one called the two mutations in CEBP alpha. There's one where you have the mutation in NPM1 but don't have one in FLIT3. And then the last one, which I consider kind of on the border, is a translocation between chromosome 8 and chromosome 21. Outside of those, everything else is either intermediate or high-risk. And why I would lump them as kind of simply as that is I'm going to treat intermediate and high-risk leukemia the same. It doesn't matter what you have at the very beginning. Our goal for every leukemia at presentation is to get rid of all the leukemia cells that we can see in the bone marrow and have the normal bone marrow cells start to make red blood cells, white blood cells, and platelets again. Normalization of the healthy marrow. And once we do that, that's what we call a remission, we're not done yet. And that's where the roads diverge on whether or not somebody is low-risk or intermediate risk or high risk. Somebody who's low-risk has a more chemo-sensitive type of leukemia and we have a really good chance of just continuing with a slightly modified regimen of the same kind of drugs that we've been using before and curing that patient without resorting to some of the more difficult challenging therapies. Everybody else needs to be considered for an allogeneic stem cell transplant, which is a tough therapeutic strategy. The goal of an allogeneic stem cell transplant is not only to get rid of the leukemia cells, but to give the patient a new immune system. And essentially what we're doing is we're taking somebody else's immune system and transplanting into the patient so that that new immune system would surveil that patient's body and if any rogue leukemia cells were to present, it would identify, attack, and kill it. It's immunotherapy that we've been doing for 30 years, well before many of these newer immunotherapy drugs have come out. And the tough part about this therapy is that new immune system sometimes will identify parts of that patient's body, their healthy organs, and start to harm them as well. And so it's a delicate balance of making sure that new immune system is strong enough to kill the leukemia cells, but not too strong to hurt the patient's other organs and cause toxicity. So that's really where we fit now in 2021. These extra targeted therapies that can bind and stop any of these mutations like FLIT3 or IDH1 or 2, you know, we're really just at the beginning of understanding where they're best used, where they're most effectively used, and kind of fixing these drugs as we go. We've got first and second generations of some of these agents, but we're continuing to improve their efficacy and help to shape the balance of the efficacy toxicity ratio. So really the mainstay, at least for now, is chemotherapy followed by either more chemotherapy versus a bone marrow transplant, with some special settings being appropriate depending on the gene mutations for some of these additional agents.
