Quiz: Molecular Risk Stratification in Acute Myeloid Leukemia

February 1, 2018

Do you know which molecular markers signify poor-risk disease in AML? And how about what makes AML a challenging disease to manage in older adult patients? Test your knowledge in our latest quiz.

Do you know which molecular markers signify poor-risk disease in acute myeloid leukemia (AML)? And how about what makes AML a challenging disease to manage in older adult patients? Test your knowledge in our latest quiz.

Question 1

Answer

A.True

For example, other than acute promyelocytic leukemia (APL), the National Comprehensive Cancer Network (NCCN) recommends standard induction chemotherapy and high-dose cytarabine consolidation for patients with AML genotypes that are identified as favorable-risk, whereas poor-risk and intermediate-risk patients should be evaluated for hematopoietic stem-cell transplant at first remission.[1]

Reference

1. Strickland SA, Shaver AC, Byrne M, et al. Genotypic and clinical heterogeneity within NCCN favorable-risk acute myeloid leukemia. Leuk Res. 2018;65:67-73.

Question 2

Answer

D.Biallelic mutations in CEBPA with FLT3-internal tandem duplication (ITD) mutation.

AML harboring biallelic CEBPA mutations withoutFLT3-ITD is considered a favorable-risk form of AML but the FLT3-ITD mutation, which occurs in approximately 25% of new cases of AML, is associated with poor prognosis.[1]

Reference

1. Strickland SA, Shaver AC, Byrne M, et al. Genotypic and clinical heterogeneity within NCCN favorable-risk acute myeloid leukemia. Leuk Res. 2018;65:67-73.

Question 3

Answer

D. A higher rate of uninsured elderly patients.

Older adults are more frequently insured than younger adults because of the Medicare program, which covers more than 90% of elderly Americans.[1]

Reference

1. Huang LW, Olin RL. Emerging therapeutic modalities for acute myeloid leukemia (AML) in older adults. J Geriatr Oncol. 2017;8:417-20.

Question 4

Answer

C. BCL11A

BCL11A is among upregulated genes that are associated with poor prognosis in AML. JAG1, C3AR1, and EML4downregulation is associated with poor AML prognosis.[1,2]

Reference

1. Miller BG, Stamatoyannopoulos JA. Integrative meta-analysis of differential gene expression in acute myeloid leukemia. PLoS One. 2010;5:e9466.

2. Dong H, Shi P, Zhou Y, et al. High BCL11A expression in adult acute myeloid leukemia patients predicts a worse clinical outcome. Clin Lab. 2017;63:85-90.

Question 5

Answer

B. KIT mutation

Core binding factor with KIT mutation is a marker of intermediate-risk AML, but is not among the molecular markers of poor-risk AML in the NCCN guidelines.