Genetic profiling in acute myeloid leukemia.

نویسندگان

  • Gillian Horne
  • John Brewin
  • Timothy Chevassut
چکیده

To the Editor: In their article on the prognostic relevance of integrated genetic profiling in patients with acute myeloid leukemia (AML), Patel et al. (March 22 issue)1 propose an elaborate riskstratification system for refining prognosis for patients with intermediate-risk AML. This stratification is based on mutational analysis by DNA sequencing of 10 individual leukemia genes in addition to standard karyotyping. However, even ignoring the impracticality of such an analysis, we consider this risk stratification to be overly complicated and unjustified. Instead, on the basis of the report’s supplementary data, we believe that only two genes are worthy of mutational screening, DNMT3A and MLL. Mutations in either of these genes predict adverse outcomes independent of other mutations, including internal tandem duplication in FLT3 (FLT3-ITD), as reported previously.2 Moreover, DNMT3A and MLL mutations define a biologic subgroup of AML patients typically presenting with myelomonocytic or blastic morphology and marked leukocytosis3 who may benefit from escalation of induction chemotherapy with dose-intensified daunorubicin.4 We propose that rapid identification of unfavorable mutations in DNMT3A and partial tandem duplication in MLL (MLL-PTD) alone is required for guiding optimal treatment in patients with newly diagnosed AML.

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عنوان ژورنال:
  • The New England journal of medicine

دوره 366 24  شماره 

صفحات  -

تاریخ انتشار 2012