Improved Diagnostics

In a relatively short time, the application of cytoge-netics to clinical decision making in AML has become almost second nature—patients with t(15;17) require all-trans-retinoic acid, those with t(8;21) or inv(16) can be successfully managed with chemotherapy alone, while those with monosomy 7 or complex abnormalities may benefit from allogeneic transplant. Given recent advances in gene expression array analyses and, perhaps, proteomics as well, there is every reason to think that many more markers predictive of outcome should be forthcoming.5051 In addition to the increased information to be gained at diagnosis, it is almost certain that we should be able to develop tests that will be capable of assaying the results of initial therapy and thus guide further treatment. Quantitative polymerase chain reaction (PCR) assays with considerable predictive power are already being applied to the treatment of accute promyelocytic leukemia and chronic myeloid leukemia (CML).5253 The lack of consistent translocations makes it more difficult to develop PCR-based tests widely applicable to all AMLs, but encouraging data with multicolor flow cytometry are emerging.54 Even without the development of any new therapies, the ability to predict those patients unlikely to be cured with chemotherapy alone and to be able to offer them a bone marrow transplant in first remission, and at the same time spare those likely cured with chemotherapy unnecessary transplant, should improve substantially the overall therapy of AML.

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