5 Questions on the Diagnosis of Acute Myeloid Leukemia

Question 1

Answer

B. One third

Median age of diagnosis is 67 years, with 54% of patients diagnosed at age 65 years or older (22% of the cases are diagnosed at age 75–84 and 10% at age > 84).[1-2]

Question 2

Answer

A. Lymphoma and breast cancer

Leukemogenic cytotoxic agents are commonly used to treat these tumors.[3]

Question 3

Answer

A. True

Patients with therapy-related APL have outcomes similar to those with de novo APL. Patients with favorable-risk cytogenetics-ie, t(15;17) and the core-binding factor cytogenetic abnormalities t(8;21), inv(16), or t(16;16)-seemingly have a more favorable clinical outcome compared to other types of therapy-related AML.[4]

Question 4

Answer

C. NPM1

Mutations in the NPM1 gene occur in 28% to 35% of cases of AML. An isolated NPM1 mutation confers a higher complete response rate than patients who are NK-AML and wild-type NPM1. However, the NPM1 mutation appears to confer an overall favorable prognosis only in the absence of FLT3-ITD in patients treated only with chemotherapy.[5]

Question 5

Answer

A. AML with BCR-ABL1 and AML with mutated RUNX1

A rare de novo AML, AML with BCR-ABL1 may benefit from treatment with tyrosine kinase inhibitors. AML patients with RUNX1 may have a poorer prognosis.[6]

References:

1. National Comprehensive Cancer Network. Acute myeloid leukemia (Version 2.2016). https://www.nccn.org/professionals/physician_gls/pdf/aml.pdf. Accessed October 22, 2016.

2. SEER Cancer Statistics Factsheets: Acute myeloid leukemia. National Cancer Institute. Bethesda, MD. Available at: http://seer.cancer.gov/statfacts/html/amyl.html. Accessed October 30, 2016.

3. Becker PS. The origin of therapy-related AML Lies Deep Within. The Hematologist. 2015;12:13.

4. Beaumont M, Sanz M, Carli PM, et al. Therapy-related acute promyelocytic leukemia. J Clin Oncol. 2003;21:2123–2137.

5. Thiede C, Koch S, Creutzig E, et al. Prevalence and prognostic impact of NPM1 mutations in 1485 adult patients with acute myeloid leukemia (AML). Blood. 2006;107:4011–4020.

6. Arber DA, Orazi A, Hasserjian R, et al. The 2016 revision to the World Health Organization classification of myeloid neoplasms and acute leukemia. Blood. 2016;127:2391–2405.