Practice Pearl 1: Diagnosing Acute Myeloid Leukemia

Amanda Brahim, PharmD, BCOP, BCPS, BCACP, and Yehuda Deutsch, MD, review important laboratory and molecular tests used for diagnosing acute myeloid leukemia.

Katie Culos, PharmD, BCOP: Amanda, I know at my institution, a lot of times when we get a transfer or a new patient who comes in that has suspected AML [acute myeloid leukemia], we have bits and pieces of information that we are trying to piece together to get our definitive diagnosis. Can you walk us through the different components that are necessary for a diagnosis of AML?

Amanda Brahim, PharmD, BCOP, BCPS, BCACP: Yes, absolutely. I’ll just cover the basics. The first types of tests that we order are generally a CBC [complete blood count], blood smear, a bone marrow aspiration, and biopsy, and then we could do some additional imaging tests. Just for the sake of completeness, we get a comprehensive metabolic panel and then we’ll do some more specific molecular tests as well.

Katie Culos, PharmD, BCOP: In those situations, say they’re coming from an outside hospital or referred to you from their primary care, and they may have some pieces of the information, will you guys repeat any of those data points at your institution; for example, repeat a bone marrow or send your own smears?

Yehuda Deutsch, MD: Cytogenetic and molecular testing is super important in AML, both for prognostic information, or outcomes, and for deciding on treatment. There are times when patients are referred to us when there are certain tests that either have not been done or not resulted, and sometimes we will repeat these tests in order to make sure we have the correct information to make the right decision for treatment.

Katie Culos, PharmD, BCOP: Amanda briefly talked about kind of the basic information that we need to have a diagnosis of AML. However, as we learn more and more about the biology of AML, we know that there is additional information that is critical for us to choose the optimal treatment pathways for our patients. Yehuda, can you talk about the additional testing you mentioned, the cytogenetics, any mutational analyses, that you routinely run at your institution to get the entire picture for that patient to then be able to treat them optimally?