Risk allocation of adult patients with non-M3 acute myeloid leukemia

In acute myeloid leukemia (AML), cytogenetic/genetic assessment is universally recognized as a critical step since karyotypic and/or molecular abnormalities have been consistently shown to play a major prognostic role. At the same time, it is also very well known that cytogenetic/genetic signature may fail in predicting individual patient’s outcome. In this view, minimal residual disease (MRD) detection promises to become a valuable biomarker to assess the quality of response after chemotherapy and possibly outline post-remissional programs based on the individual risk of relapse. As a matter of fact, the choice of post-remission therapy for adults with AML still largely relies on the one size fits all principle, therefore there is confidence that MRD determination will help refine risk-allocation leading to more appropriate, risk-adapted post-remissional interventions. In the present review, we will discuss the impact of cytogenetics and genetics on outcome of patients with AML and the role that a biomarker such as MRD might have if incorporated in our current risk-assessment algorithms. A comprehensive biological risk-assessment including cytogenetic/genetic profile and MRD determination would possibly allow tailored therapeutic strategies to be adopted, avoiding situations of under or overtreatment.