Toward Individualized Therapy in Acute Myeloid Leukemia

Acute myeloid leukemia (AML) is a heterogeneous disease in its clinical presentation, response to therapy, and overall prognosis. For decades, pretreatment karyotype evaluation has served to identify subgroups for risk-adapted postremission therapy, but the initial treatment approach has been largely unchanged. With continued advances in the genetic and epigenetic characterization of AML, we have discovered even more diversity and are starting to understand the biological underpinnings of these multiple disease entities. Newer therapies are being developed to address the pathophysiology within these individual AML subsets. This review categorizes AML into biologically defined groups based on currently available data and describes the evolving treatment approaches within these groups. Identifying the genetic abnormalities and biological drivers prior to AML treatment will be important as we work to individualize therapy and improve outcomes.