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Pathogenese und molekulare Diagnostik der akuten myeloischen Leukämie

Pathogenesis and molecular diagnosis of acute myeloid leukemia

  • Leitthema
  • Published:
Die Onkologie Aims and scope

Zusammenfassung

Hintergrund

Die akute myeloische Leukämie (AML) ist eine klonale Erkrankung hämatopoetischer Stamm- und Progenitorzellen des Knochenmarkes mit einem Altersgipfel im fortgeschrittenen Erwachsenenalter. Akute myeloische Leukämien können sowohl spontan und de novo als auch hereditär infolge von Keimbahnmutationen, sekundär aus anderen hämatologischen Erkrankungen oder therapie-induziert nach vorausgegangener Chemo- oder Strahlentherapie entstehen. Unabhängig vom Entstehungsmechanismus sind alle Formen der AML auf die klonale Expansion hämatopoetischer Vorläuferzellen mit rekurrenten Treibermutationen in Onkogenen und Tumorsuppressoren oder chromosomalen Aberrationen zurückzuführen.

Schlussfolgerung

Insbesondere moderne Sequenzierungsmethoden haben in den letzten Jahren zu der Erkenntnis geführt, dass die Expansion hämatopoetischer Klone mit bestimmten Treibermutationen bei gesunden Personen mit zunehmendem Lebensalter häufig nachzuweisen und mit einem erhöhten Risiko des Auftretens einer AML verbunden ist. Der Nachweis molekularer Aberrationen gehört mittlerweile zur Primärdiagnostik der AML und ist sowohl von prognostischer als auch therapeutischer Bedeutung. Im weiteren Erkrankungsverlauf und nach Abschluss der Therapie werden initial nachgewiesene Mutationen zur Bestimmung der messbaren residuellen Erkrankung (MRD) verwendet, die ebenfalls prognostisch bedeutsam ist und die Möglichkeit präemptiver Therapien bereits vor dem Auftreten eines hämatologischen Rezidivs eröffnet.

Abstract

Background

Acute myeloid leukemia (AML) is a clonal disorder of hematopoietic stem and progenitor cells in the bone marrow with a rising frequency with increasing age. Acute myeloid leukemias can develop both spontaneously and de novo as well as a consequence of hereditary germ line mutations and secondary to other hematological malignancies and cytotoxic chemo- and radiotherapy. All types of AML derive from hematopoietic cells, which clonally expand due to driver mutations in oncogenes and tumor suppressors or chromosomal aberrations that confer a selective growth advantage.

Conclusion

During recent years, modern sequencing technologies have led to the realization that in healthy individuals hematopoietic cell clones with mutations in certain driver genes expand with increasing age, a phenomenon that is associated with an increased risk of developing acute myeloid leukemia. Because of its prognostic and therapeutic relevance, the analysis of molecular aberrations meanwhile is an integral part of the initial diagnostic process in patients with AML. Mutations detected at first diagnosis further serve for measurable residual disease (MRD) detection during treatment and after completion of therapy, which is of prognostic impact as well and of relevance for implementation of preemptive treatments already ahead of full-blown hematologic relapse.

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  1. Klinische Kooperationseinheit Molekulare Hämatologie/Onkologie, Deutsches Krebsforschungszentrum (DKFZ) und Medizinische Klinik V, Universität Heidelberg, Im Neuenheimer Feld 280, 69120, Heidelberg, Deutschland

    Alwin Krämer

  2. Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus Dresden, Dresden, Deutschland

    Christian Thiede

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Correspondence to Alwin Krämer.

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A. Krämer: Speaker: Hoffmann-La Roche; Advisory Boards: Hoffmann-La Roche, AbbVie; Research funding: BMS, Bayer. C. Thiede: Co-Ownership: AgenDix GmbH; Advisory Boards: Novartis, Astellas, JAZZ; Speaker: Novartis, JAZZ, Astellas.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Krämer, A., Thiede, C. Pathogenese und molekulare Diagnostik der akuten myeloischen Leukämie. Onkologie 28, 463–473 (2022). https://doi.org/10.1007/s00761-022-01183-y

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  • DOI: https://doi.org/10.1007/s00761-022-01183-y

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