Akute myeloische Leukämie bei Erwachsenen

Abstract

There are several changes in the revised WHO classification for acute leukemia. The latest version of the European Leukemia Network (ELN)-risk classification defines AML with mutations in RUNX1, ASXL1 or TP53 to fall in the unfavorable risk group. Consequently, the somatic molecular genetic testing at the time of initial diagnosis should encompass these before mentioned three genes next to the already routine testing of NPM1, CEBPA and FLT3-ITD. Several new innovative substances have been developed and approved for AML therapy. The multikinase inhibitor midostaurin is a new substance in the induction therapy for patients with FLT-3 mutated AML. CPX-351 (cytarabin and daunorubicin in liposomatic formulation in a defined molar relation) is a new option for therapy associated AML and AML with myelodysplastic changes. Enasidenib is a targeting drug for relapsed or refractory AML with IDH2 mutation. Gemtuzumab, a CD33 + antibody-drug-conjugate is approved for CD33 positive cases.

Mittlerweile sind viele neuartige und zielgerichtete Substanzen in der Therapie der AML verfügbar. Durch die Fortschritte in der Molekulargenetik lassen sich zielgerichtete Therapieoptionen ableiten. Umso wichtiger sind eine präzise und vor allem rasche zyto- und molekulargenetische Charakterisierung der AML sowie die Risikobestimmung. Dieser Beitrag legt den Schwerpunkt auf Neuerungen in der Klassifikation und bei den Therapieansätzen.

Schlüsselwörter

AML - zielgerichtete Therapie - Risikoklassifikation

Key words

AML - targeted therapy - risk classification

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