Ann-Kathrin Eisfeld, MD, assistant professor, director, Clara D. Bloomfield Center for Leukemia Outcomes Research, Division of Hematology, member, Leukemia Research Program, The Ohio State University Comprehensive Cancer Center (OSUCC) –James, discusses factors to consider when deciding whether to start treatment right away or wait for molecular testing results in patients with acute myeloid leukemia (AML).

The decision to start treatment or wait for molecular test results can vary between differenthematologists and oncologists, and it is up to the treating physician’s discretion to decide which approach is correct for each given patient with AML, Eisfeld says. She explains that in many cases, it can be appropriate to wait to allow the test results to help drive treatment decisions; however, she notes there are some exceptions.

If a patient being treated is suspected to have acute promyelocytic leukemia based on morphology or presence of tumor-initiating cells, she will start treatment with all-trans retinoic acid (ATRA), and adjustments can be made following the molecular testing results.

Eisfeld also explains that she will start treatment right away if a patient presents with signs of organ damage, such as compromised respiratory function or a high white blood cell count. Patients who have a complex karyotype, such as those with 

 mutation, may need to start treatment prior to the conclusion of full molecular testing, she adds, noting that those with 

 mutations generally do not respond well to conventional chemotherapy.

However, in most other instances, other traditional measures that could eliminate suspicion of a complex karyotype could allow physicians to justify waiting for full molecular test results prior to starting treatment, Eisfeld details.

 mutations prior to starting treatment would be ideal, particularly for older patients, as they may be eligible to receive oral therapy rather than intravenous therapy, Eisfeld concludes.

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Ann-Kathrin Eisfeld, MD, discusses factors to consider when deciding whether to start treatment right away or wait for molecular testing results in patients with acute myeloid leukemia.


Dr Eisfeld on Timing of Molecular Testing and the Start of Treatment in AML

Ann-Kathrin Eisfeld, MD, assistant professor, director, Clara D. Bloomfield Center for Leukemia Outcomes Research, Division of Hematology, member, Leukemia Research Program, The Ohio State University Comprehensive Cancer Center–James, discusses recent changes to the classification of acute myeloid leukemia (AML), and potential challenges accompanying these new guidelines.

One of the most highly discussed changes is the new classification of AML myelodysplasia-related changes (AML-MRC) in the World Health Organization classification of AML, Eisfeld begins. Prior to the updated recommendations, this biologic subtype of AML was identified through quantitative and qualitative evaluations. The tumor was required to be evaluated under a microscope to grade dysplasia, or a patient must have had a known history of, or hereditary predisposition to, myelodysplastic syndrome (MDS), Eisfeld explains.

With recent advances in the understanding of disease biology in AML, this approach is no longer required, Eisfeld states. Instead, patients may be diagnosed with AML-MRC in the absence of identifiable MDS if they display certain genetic mutations, she continues. The justification for the inclusion of this new category is that genetic changes associated with AML are heterogeneous and are often associated with poorer prognosis, Eisfeld says. However, more research still needs to be done to identify how clinicians should proceed if patients display favorable risk markers.

Ultimately, the inclusion of these genetic markers in updated classification guidelines can allow patients to be diagnosed sooner. In turn, these patients may qualify for first-line treatment options other than conventional chemotherapy, such as venetoclax (Venclexta) and CPX-351 (Vyxeos), Eisfeld concludes.

Ann-Kathrin Eisfeld, MD, discusses recent changes to the classification of acute myeloid leukemia, and potential challenges accompanying these new guidelines.



Ann-Kathrin Eisfeld, MD

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Dr Eisfeld on Timing of Molecular Testing and the Start of Treatment in AML

Dr Eisfeld on Updated Guidelines for the Classification of AML