Acute myeloid leukemia (AML) is the most common acute leukemia in adults, comprising 1% of all cancers . Major improvements in pathophysiological insights, in part due to the use of novel technologies, have revolutionized the diagnostic, prognostic, and therapeutic landscape of AML . In the last few years, new diagnostic classification systems and prognostic algorithms were introduced [3‒5] based on our enhanced understanding of the interplay of biology and clinical outcome. Our ability to measure small numbers of diseased cells (measurable residual disease) improved and influenced clinical decisions on a daily basis [6, 7]. Importantly, at least 12 agents or combination therapies were recently approved for AML [8‒19]. These advances allow individualization of therapy, thereby leading to better outcomes in patients with AML. Such therapeutic advances require a comprehensive assessment of both patients and their diseases.
We present a series of reviews on various controversies in AML which should aid clinicians in optimizing care (Fig. 1). After a comprehensive review of AML pathophysiology, we present a review of new AML classification systems, noting similarities and differences between the two classifications. A major issue vexing clinicians, how to integrate measurable residual disease measurement into daily practice, is discussed in detail. The therapeutic landscape is covered in treatises reviewing optimal post-remission approaches and both immunotherapy and non-immunotherapeutic advances in advanced disease. We provide a focus on two important and challenging populations with AML, older patients and those harboring TP53 mutations. Finally, we present a review on the controversial topic of prophylactic antibiotic therapy in AML. We hope that our review series will serve as a tool kit to help clinicians resolve the uncertainty and complexity inherent in modern AML management.
This review series is dedicated to the recently deceased Prof. Ben-Bassat, a pioneer and a leader in Israeli hematology, who served as the editor-in-chief of Acta Haematologica for several decades. We have therefore included an obituary written by the current editor-in-chief, Prof. Pia Raanani.
Conflict of Interest Statement
R.M.S. reports consulting fees from Abbvie, Aptevo, Aprea, Arog, BMS, CTI Pharma, Curis Oncology, Epizyme, GSK, Hermavant, Ligand Pharma, Lava Therapeutics, Redona Therapeutics, and Takeda. S.S. has no COI to declare.
No funding was received.
S.S. conceived and wrote the editorial. R.M.S. conceived and edited the editorial.