WHO 2016: CLASSIFICATION OF HIGH-RISK AML SUBTYPES: t-AML AND AML-MRC

THERAPY-RELATED AML (T-AML)

According to WHO, t-AML is defined as previously untreated AML with a history of prior cytotoxic therapy1,2*

Cytotoxic therapies associated with development of t-AML2 :

  1. Alkylating agents and radiation
    1. Latency period of 4–10 years
  2. Topoisomerase II inhibitors
    1. Latency period of 2–3 years
  3. Immunosuppressive therapies
    1. Latency period of 3–4 years

AML, WITH MYELODYSPLASIA-RELATED CHANGES (AML-MRC)

AML: ≥20% blasts in peripheral blood2

AML arising from a prior MDS or an MDS/MPN2

OR

AML with an MDS-related cytogenetic abnormality2

OR

AML with multilineage dysplasia2

A diagnosis of AML-MRC may require cytogenetic testing or a morphology exam for confirmation1

aml-history
aml-history

The classification of AML has been updated to reflect breakthroughs in disease understanding1,3,4

  • The VYXEOS indication is based on the WHO 2016 classification of AML1
  • The 2022 WHO and ICC classifications have revised the definition of AML-MRC and t-AML3,4
classification-en-desk
classification-en-mob

Myelodysplasia-related cytogenetic abnormalities as described in the WHO 2022 and ICC 2022 Guidelines

The WHO 2022 and ICC classifications share overlapping cytogenetic abnormalities

who-classification
who classification

BM: Bone marrow

ICC: International Consensus Classification

MDS: Myelodysplastic syndrome

MPN: Myeloproliferative neoplasm

pCT: Post cytotoxic therapy

WHO: World Health Organization

*Antimetabolites, antimicrotubule agents, growth factors, and immunomodulators have also been implicated in t-AML.2

References: 1. Arber DA, Orazi A, Hasserjian R, et al. The 2016 revision to the World Health Organization classification of myeloid neoplasms and acute leukemia. Blood 2016;127: 2391–2405. 2. Czader M, Orazi A. Therapy-Related Myeloid Neoplasms. Am J Clin Pathol 2009;132(3):410–425. 3. Khoury JD, Solary E, Abla O, et al. The 5th edition of the World Health Organization Classification of Haematolymphoid Tumours: Myeloid and Histiocytic/ Dendritic Neoplasms. Leukemia 2022;36:1703–1719. 4. Arber DA, Orazi A, Hasserjian RP, et al. International Consensus Classification of Myeloid Neoplasms and Acute Leukemias: integrating morphologic, clinical, and genomic data. Blood 2022;140:1200–1228.

CA-VYX-2400006-E | March 2024