Dr. Wang: Hello, my name is Dr. Eunice Wang, the Chief of the Leukemia Service at the Roswell Park Comprehensive Cancer Center in Buffalo, New York. I'm here to address a really important question. After you have a diagnosis of acute myeloid leukemia or AML, what is the next step? Is AML all alike and what tests are needed? And when do you need to have them done? Now? Is it possible to wait? This is a very important question because over the last three or four years, there has been the introduction of seven, eight, nine new drugs for the treatment of AML or acute myeloid leukemia. However, the ability or the opportunity to use these drugs is very dependent on the characteristics of your particular leukemia type.
Are All Diagnoses of AML the Same?
So, it's very important at the time that the AML is diagnosed that all of the appropriate tests are done to determine if it's possible for you to be treated with what we call targeted therapy. The tests that we typically offer or require at the time of an AML diagnosis include typically a bone marrow biopsy or collection of blood samples, and performance of many specific different diagnostic testing. This testing includes not only the pathologist looking at what the cells look like and confirming that they are cancer cells and they are myeloid type cells, but also testing to look for certain tumor markers. These tumor markers include proteins or things that are expressed on the cell surface that could be targets for antibodies or other protein-based attacks.
What Genetic Mutations Are Seen in AML?
They also include analysis of the DNA and the RNA of the cancer cells to look for specific chromosome and genetic abnormalities, as well as gene mutations. The identification of gene mutations, including FLT3, IDH1 and IDH2, allows us to not only prognosticate or predict how you would do with chemotherapy, but also would be essential to determine whether treatment with oral or pill medications targeting those specific mutations might be an option for you and would be recommended to improve your outcomes.
What Diagnostic Tests Are Important for Acute Myeloid Leukemia?
These tests are typically done by the oncologist or the cancer specialist that is seeing you at the time of this leukemia diagnosis. And then it's important that because acute myeloid leukemia can be really complicated and very diverse that you go to a center or a physician or a specialist who knows what AML is and is able to order the appropriate tests of that bone marrow and blood test to determine what would be the best therapy for you.
So, AML is not always alike. That FLT3 mutation that I mentioned is only found in about 27% to 34% of acute myeloid leukemia cases. So it's not 100%. Just like people, everybody has a little difference between even people in the same family. There are key genetic differences, personality differences. Each type of AML is a little bit different, and it's important to characterize those mutations in order to allow us to tailor your therapy to what might work best for you and what might offer you the least amount of side effects. So it's important to get those tests done and to see a specialist who is familiar with AML in order to get the most treatment options and to design a treatment plan that's individualized for your particular cancer type.
