What is genetic testing and what can it tell you about someone's AML? Genetic testing and AML is really important because it does two things for us. One is it tells us about what we expect that that particular person's leukemia is likely to act in terms of its prognosis and its response to treatment. We have several genetic pieces of information that we need to get at the very beginning of diagnosing and developing a treatment plan because these pieces of information are going to color not only what is this patient's prognosis but also how likely are they to respond to different types of therapeutic interventions. Most commonly for cancer we still nowadays use chemotherapy. Drugs and treatments aim to kill dividing cells. What we've learned over the last four to five decades is that some mutations make a leukemia more sensitive to chemotherapy, which is great because that helps us to know if a patient has a very chemo sensitive leukemia what kind of mileage we can expect from getting a patient through a very tough chemotherapeutic regimen. Whereas there are some mutations that will tell us that you know what we may not expect to get very far with just chemotherapy alone and so we need to be a little bit more thoughtful, a little more strategic, and a little bit more in how we develop a treatment plan. The discussion of which option brings in all of the biology that we've learned about the patient's leukemia. So what it looks like under the microscope, what the genetics show, what the molecular testing shows, as well as the patient's overall health. How healthy is the patient? Do they have other medical problems that will impact and impede our ability to try to cure this disease? And you take that together and then try to understand the patient's goals and acceptance of risks and benefits. And together with that information you have to develop the plan. So many times they can be done on peripheral blood samples if it's clear that there are a lot of leukemia cells circulating in the blood. So it is possible. However, typically the standard would be to do a bone marrow aspirate and biopsy to more fully characterize the leukemia at the initiation of therapy. And of course to look for remission would require a bone marrow biopsy to be performed after therapy to prove that the leukemia is on the run. You can't do a remission analysis just from the peripheral blood.
