LAUSR

Acute myeloid leukemia with myelodysplasia-related changes (AML-MRC) is a high-risk AML subtype with a reported frequency of 24% to 35% of all AMLs. 1-3 AMLs that develop after prior therapy (therapy-related myeloid neoplasms), with recurrent genetic abnormalities and those with NPM1 or biallelic CEBPA mutations, are excluded regardless of morphologic dysplasia. 4,5 AML-MRC diagnosis is straightforward when there is an antecedent history of myelodysplastic syndrome (MDS) or myelo-dysplastic/myeloproliferative neoplasm (MDS/MPN) or when dysplasia (>50%) is present in at least 2 cell lineages. However, when these conditions are not met, the diagnosis depends on World Health Organization – de fi ned MDS-associated cytogenetic abnormalities. In general, the complexity of modern hematopathology diagnoses requires the timely incorporation of cytogenetics/ fl uorescence in situ hybridization (FISH) and/or molecular fi ndings. 6 AML-MRC, similar to therapy-related AML, is associated with a poor prognosis 2 and lower response rates using conventional chemotherapy. 7-9 Based on better survival data, the US Food and Drug Administration approved CPX-351 (Vyxeos, Jazz Pharmaceuticals), a fi xed-dose liposomal formulation of daunorubicin and cytarabine for the treatment of AML-MRC and therapy-related MRC. 7 In addition, alternative treatments including lower intensity therapies (hypomethylating agents with or without