Suboptimal Adherence to Guideline-Recommended Molecular Testing in Patients with Newly Diagnosed AML: Data from the Connect MDS/AML Disease Registry

Conference Correspondent - ASCO 2017 - Acute Myeloid Leukemia, Conference Correspondent

While the identification of recurrent mutations in acute myeloid leukemia (AML)-associated genes has prognostic value and may help guide treatment decisions, little is known about molecular genetic testing patterns for AML in clinical practice. Prior analyses of the Connect MDS/AML Disease Registry (George, et al. ASH 2016. Abstract 3548) showed suboptimal adherence to World Health Organization 2008 recommendations for AML in a cohort of patients with newly diagnosed AML.

This analysis of the Connect MDS/AML Disease Registry evaluated patterns of molecular genetic testing in a similar patient population in community and academic settings. The current analysis evaluated the percentage of patients with AML with molecular genetic testing recommended by National Comprehensive Cancer Network (NCCN) guidelines. Tests included were for NPM1, FLT3-ITD, CEBPA, IDH1, IDH2, DNMT3A, and KIT. Statistical analyses evaluated the effects of several variables—including site of care, karyotype, age, and type of insurance coverage—on likelihood of molecular genetic testing.

During the 3-year study period, 259 patients with AML were enrolled at 86 sites. Overall, molecular genetic testing was reported in 67% (173/259) of patients. Younger patients, patients treated at academic versus community sites, patients with normal versus abnormal karyotype, and patients with non-Medicare versus Medicare insurance were all more likely to receive testing. There was substantial variance in testing for specific mutations, with only 6% (n = 6) receiving all 4 NCCN-recommended molecular genetic tests in patients with normal karyotype. Of the NCCN-recommended tests, those for FLT3-ITD (81%) and NPM1 (80%) were most often reported, and TP53 (14%) was least often reported.

On a positive note, the data from the Connect MDS/AML Disease Registry indicate that two-thirds of newly diagnosed patients with AML receive molecular testing for recurrent mutations. However, a closer look reveals that the majority does not receive guideline-recommended testing. Although further analysis of testing patterns is warranted, the data reveal an opportunity to educate providers about appropriate testing recommended by NCCN.

Pollyea DA, et al. ASCO Abstract 7022.

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