Inside the Clinic: Experts Discuss Testing for Molecular Abnormalities in AML

Maher Albitar, MD, founder, chief executive officer, chief medical officer of Genomic Testing Cooperative, and Andre H. Goy, MD, physician in chief of the Hackensack Meridian Health Oncology Care Transformation Services, chairman and chief physician officer at John Theurer Cancer Center at Hackensack University Medical Center, and Lymphoma Division Chief at John Theurer Cancer Center, discuss the importance of testing for molecular abnormalities in acute myeloid leukemia (AML).

The AML treatment landscape is growing rapidly and becoming increasingly complex, and investigative measures have evolved past the abilities of cytogenetics and fluorescence in situ hybridization (FISH) testing, Goy says. Instead, extensive molecular profiling is effective at identifying high-risk patients to best customize their treatment. Instead of being tested for individual suspected mutations, patients should receive one comprehensive test to reveal the entire genomic profile of their disease, Goy adds.

Advances in DNA and RNA next-generation sequencing (NGS) have allowed for greater visibility of genetic abnormalities, immunophenotypes, and heterogeneities within AML, Albitar says. Additionally, as leukemias are immersed in the blood, liquid biopsy is a reliable means of evaluating disease status and detecting these molecular and cytogenetic abnormalities.

Tracking the clonal evolution of molecular abnormalities over time is essential for identifying mutations and administering effective treatment, Goy adds. Strategic treatment produces better survival outcomes with more tolerable toxicity.

Each patient is different, and new combination therapies, especially those being introduced in clinical trials, offer opportunities to find better biomarkers for determining which combinations to use for which patients, Albitar says. NGS is becoming an important routine practice for clinical decisions and monitoring patient responses to targeted therapies, Goy concludes.