Introduction: The Shift in Acute Myeloid Leukemia Management
For decades, the standard of care for acute myeloid leukemia (AML) was defined by intensive induction chemotherapy. However, for a significant portion of the patient population—particularly the elderly or those with substantial comorbidities—intensive treatment was often intolerable. The landscape of hematologic oncology changed dramatically with the emergence of Venetoclax (VEN) in combination with hypomethylating agents (HMA), such as azacitidine or decitabine. This combination has demonstrated high rates of complete remission and improved overall survival (OS) in patients previously deemed ineligible for intensive therapy.
Despite these advances, clinicians have long observed a frustrating variability in patient outcomes. Some patients achieve durable, multi-year remissions, while others progress rapidly despite initial response. Existing prognostic frameworks, primarily the European LeukemiaNet (ELN) risk classifications, were largely validated in the context of intensive chemotherapy. There is a pressing clinical need for tools that specifically account for the genomic landscape of AML in the era of BCL-2 inhibition.
