Service d’hématologie, Hôpital Avicenne, Bobigny
The recent identification of new prognostic factors for AML outcome has made an important contribution to the management of adult AML. Although cytogenetic testing, age and performance status remain essential in AML prognosis, a recent advance consists in the identification of molecular biological markers (FLT3, NPM1, C/EBP alpha, C-kit, DNMT3A, TET2, IDH1/2) that have direct and independent impact on survival. MAL management in young subjects, in particular, has benefitted from the development of targeted therapies, in association with traditional chemotherapy combining aracytin and an anthracylcin. The recent targeted therapies use inhibitors of these new prognostic markers (FLT3 inhibitors) and antibodies, in addition to combating MDR mechanisms and mobilizing stem cells. In AML management in elderly subjects, recent advances concern the use of new molecules such as hypomethylating agents, and the use of lenalidomide or clofarabine. This has made it possible to significantly improve survival rates in these patients.