Indications for Testing

Thorough laboratory investigation of AML is fundamental to the successful clinical management of the disease, fulfilling diagnostic and prognostic roles. Prognostic factors in AML can be subdivided into pretreatment and post-treatment factors (see Table 30-5). With the exception of age and type of AML (de novo vs secondary), pretreatment determination of the likely outcome to therapy is dependent on laboratory investigation, with karyotype and NPM1 and FLT3 mutation status being the most important factors identified to date.5,13,14 Predicting likely outcome following initiation of therapy falls entirely within the realm of the laboratory and, for patients in morphological complete remission (CR) after initiation of treatment, is dependent on the detection of minimal residual disease (MRD), for which a number of technologies have been developed (see Rationale for MRD Monitoring below).

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