Fig. 2: Factors indicating eligibility for HSCT in newly diagnosed pediatric AML.
From: The hallmarks of hematopoietic stem cell transplantation for pediatric acute myeloid leukemia
High-risk features in pediatric AML are defined by cytogenetic and molecular abnormalities, as well as poor response to treatment as indicated by measurable residual disease: 1Karyotypic Abnormalities: Complex karyotype (≥3 aberrations including at least one structural abnormality), excluding cases with recurrent translocations; monosomal karyotype, such as monosomy 7 or deletion 5q (-7, -5/del(5q)). 2Chromosomal Translocations: t(16;21)(p11;q22)→FUS::ERG; t(9;22)(q34;q11.2) → BCR::ABL1; t(6;9)(p22;q34) → DEK::NUP214; t(7;12)(q36;p13) → MNX1::ETV6; inv(3)(q21q26)/t(3;3)(q21;q26) → RPN1::MECOM; inv(16)(p13q24) → CBFA2T3::GLIS2; t(5;11)(q35;p15.5) → NUP98::NSD1; t(11;12)(p15;p13) → NUP98::KDM5A; 12p abnormalities; 11q23/KMT2A rearrangements, including: t(4;11)(q21;q23) → KMT2A::AFF1; t(6;11)(q27;q23) → KMT2A::AFDN; t(10;11)(p12;q23)→KMT2A::MLLT10. 3Monogenic HSCT Classifiers: FLT3-ITD with an allelic ratio (AR) ≥ 0.5, either alone or in combination with other recurrent abnormalities or NPM1 mutations. 4Measurable Residual Disease (MRD): Multiparametric flow cytometry (MFD)-MRD ≥0.1% after first or second induction or (if MFC-MRD result is not available/ informative) blast count ≥5% at second induction. HR high-risk, KMT2A Histone-Lysin-N-Methyltransferase 2A, AFD Afadin, Adherents Junction Formation Factor, MLLT10 Histone Lysine Methyltransferase DOT1L Cofactor, FUS RNA Binding Protein, ERG ETS transcription factor, BCR Breakpoint cluster region, ABL1 Abelson Murine Leukemia Viral Oncogene Homolog 1, DEK protoonko-gene, NUP nucleoporin, MNX1 Motor Neuron And Pancreas Homeobox 1, ETV6 ETS Variant Transcription Factor 6, RPN1 Ribophorin I, MECOM MDS1 And EVI1 Complex Locus, FLT3 FMS-like tyrosine kinase 3, ITD internal tandem duplication, NPM1 nucleophosmin 1, WT1 Wilms Tumor 1, CBFAT3 CBFA2/RUNX1 Partner Transcriptional Co-Repressor 3, GLIS2 GLIS Family Zinc Finger 2, NSD1 Nuclear Receptor Binding SET Domain Protein 1, KDM5A Lysine Demethylase 5A, MFC multiparametric flow cytometry, MRD measurable residual disease, MRD.
