Rethink the potential of your patients
Know the seriousness
of
their sAML
diagnosis
sAML is a broad category of high-risk AML that includes multiple subtypes of leukemias with different characteristics but similar poor prognosis and significant challenge to reach a cure.1,2

SUBTYPES OF sAML
sAML includes multiple subtypes of high-risk AML1,2
As of 2016, sAML includes therapy-related AML (t-AML), AML with antecedent hematologic disease (AHD), and de novo AML with myelodysplastic related changes (MRC).1
t-AML accounts for up to 10% of all AML cases and is defined as AML arising after exposure to chemotherapy or radiotherapy for previous malignancies.1,3
Prior malignancies
associated with t-AML4,a
- 3%Acute lymphoblastic leukemia
- 4%Multiple myeloma
- 10%Rheumatic disease
- 32%Lymphoproliferative disorder
- 51%Solid cancer
aDistribution of previous disease in 203 patients with t-AML regardless of treatment intent. Data from a national, population-based study of 3055 patients diagnosed with AML from 2000 to 2013 in Denmark.4
Prior malignancies associated with t-AML4,a
aDistribution of previous disease in 203 patients with t-AML regardless of treatment intent. Data from a national, population-based study of 3055 patients diagnosed with AML from 2000 to 2013 in Denmark.4
AML-MRC accounts for up to 35% of all AML cases,5,b but can still be difficult to identify because of its multifaceted nature1,2
The 2016 WHO classification defines AML-MRC as ≥20% blasts in the peripheral blood or bone marrow and ANY of the following6,7:
MDS
Previously documented
MDS or MDS/MPN
Non-MDS
Myelodysplasia-related
cytogenetic
abnormalitiesc-e
Multilineage dysplasia: Dysplasia present in ≥50% of
cells in
at least
2 myeloid cell lines, unless an NPM1
mutation or
biallelic mutation of CEBPA is present
A majority of AML-MRC cases DO NOT present with a documented history of MDS or MDS/MPN.8,f


PATIENTS WITH AML-MRC WHO PRESENTED WITHOUT ANTECEDENT HEMATOLOGICAL DISORDER8,f
As AML-MRC often occurs as de novo AML with MDS-related
cytogenetic changes or multilineage dysplasia, patients
with
AML-MRC may go unidentified without comprehensive
testing.9
Genetic testing for driver mutations of AML can help identify patients with sAML who have greater need for intensive treatment.10
- Patients with mutations in SRSF2, SF3B1, U2AF1, ZRSR2, ASXL1, EZH2, BCOR, and STAG2 genes are at risk of evolution from MDS into AML2
- 78% of patients with sAML present with pan-AML mutations, such as those of myeloid transcription factors (RUNX1, CEBPA, GATA2) and signal transduction proteins (FLT3 or RAS pathway)2
- 15% of sAML cases present with mutations in the TP53 gene, characterized by poor prognosis2
Fully identifying the AML subtype is important to choosing
treatment,
and studies have shown delaying
treatment for genetic and laboratory testing does not negatively
impact outcomes.11,12,g
CEBPA=CCAAT/enhancer-binding protein-alpha; ECOG=Eastern Cooperative Oncology Group Performance Status; IC=intensive chemotherapy; MDS=myelodysplastic syndromes; MPN=myeloproliferative neoplasm; NPM1=nucleophosmin-1; SAL=Study Alliance Leukemia; WHO=World Health Organization.
bIncidence is variable based on the definition of AML-MRC used.5
cComplex karyotype: 3 or more abnormalities.7
dUnbalanced abnormalities: -7/del(7q), del(5q)/t(5q), i(17q)/t(17p), -13/del(13q), del(11q), del(12p)/t(12p), idic(X)(q13).7
eBalanced abnormalities: t(11;16)(q23.3;p13.3), t(3:21)(q26.2;q22.1), t(1;3)(p36.3;q21.2), t(2;11)(p21;q23.3), t(5;12)(q32;p13.2), t(5;7)(q32;q11.2), t(5;17)(q32;p13.2), t(5;10)(q32;q21.2), t(3;5)(q25.3;q35.1).7
fStudy of 175 adult patients with AML-MRC classified by 2008 WHO criteria.8
gTwo studies looked at the effect of time from diagnosis to treatment start on patient prognosis: results from a retrospective study in patients with de novo AML or sAML aged ≥60 years (n=664)12 and an analysis of real-world SAL-AML registry data of patients with newly diagnosed AML, including sAML (n=2263).11
Efficacy
VYXEOS is the only FDA-approved intensive chemotherapy that delivers on key treatment milestones needed to beat sAML better than 7+3.13,14 Learn more about lasting remission, increased chance of HSCT, and prolonged survival.
more
Safety
The safety profile of VYXEOS in the Phase 3 study was comparable with 7+3, with similar types and severity of adverse reactions.15
more
References: 1. Lalayanni C, Gavriilaki E, Athanasiadou A, et al. Secondary acute myeloid leukemia (sAML): similarly dismal outcomes of AML after an antecedent hematologic disorder and therapy related AML. Clin Lymphoma Myeloma Leuk. 2022;22(4):e233-e240.
2. Capelli D, Menotti D, Florentini A, Sarcani F, Olivieri A. Chapter 7: Secondary acute myeloid leukemia: pathogenesis and treatment. Accessed March 21, 2024. https://www.ncbi.nlm.nih.gov/books/NBK586211/?report=printable
3. Leone G, Mele L, Pulsoni A, et al. The incidence of secondary leukemias. Haematologica. 1999;84(10):937-945.
4. Granfeldt Østgård LS, Medeiros BC, Sengeløv H, et al. Epidemiology and clinical significance of secondary and therapy-related acute myeloid leukemia: a national population-based cohort study. J Clin Oncol. 2015;33(31):3641-3649.
5. National Cancer Institute Surveillance, Epidemiology, and End Results Program. SEER hematopoietic and lymphoid neoplasm database: acute myeloid leukemia with myelodysplasia-related changes. Accessed March 21, 2024. https://seer.cancer.gov/seertools/hemelymph/
51f6cf58e3e27c3994bd53ae/?q=aml-mrc
6. Vardiman JW, Thiele J, Arber DA, et al. The 2008 revision of the World Health Organization (WHO) classification of myeloid neoplasms and acute leukemia: rationale and important changes. Blood. 2009;114(5):937‐951.
7. Arber DA, Orazi A, Hasserjian R, et al. The 2016 revision to the World Health Organization classification of myeloid neoplasms and acute leukemia. Blood. 2016;127(20):2391‐2405.
8. Miesner M, Haferlach C, Bacher U, et al. Multilineage dysplasia (MLD) in acute myeloid leukemia (AML) correlates with MDS-related cytogenetic abnormalities and a prior history of MDS or MDS/MPN but has no independent prognostic relevance: a comparison of 408 cases classified as “AML not otherwise specified” (AML-NOS) or “AML with myelodysplasia-related changes” (AML-MRC). Blood. 2010;116(15):2742-2751.
9. Arber DA, Erba HP. Diagnosis and treatment of patients with acute myeloid leukemia with myelodysplasia-related changes (AML-MRC). Am J Clin Pathol. 2020;154(6):731-741.
10. Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Acute Myeloid Leukemia V.2.2024. © National Comprehensive Cancer Network, Inc. 2024. All rights reserved. Accessed April 3, 2024. To view the most recent and complete version of the guideline, go online to NCCN.org.
11. Röllig C, Kramer M, Schliemann C, et al. Does time from diagnosis to treatment affect the prognosis of patients with newly diagnosed acute myeloid leukemia? Blood. 2020;136(7):823-830.
12. Sekeres MA, Elson P, Kalaycio ME, et al. Time from diagnosis to treatment initiation predicts survival in younger, but not older, acute myeloid leukemia patients. Blood. 2009;113(1):28-36.
13. VYXEOS [package insert]. Palo Alto, CA: Jazz Pharmaceuticals.
14. Lancet JE, Uy GL, Newell LF, et al. CPX-351 versus 7+3 cytarabine and daunorubicin chemotherapy in older adults with newly diagnosed high-risk or secondary acute myeloid leukaemia: 5-year results of a randomised, open-label, multicentre, phase 3 trial. Lancet Haematol. 2021;8(7):e481-e491.
15. Lancet JE, Uy GL, Cortes JE, et al. CPX-351 (cytarabine and daunorubicin) liposome for injection versus conventional cytarabine plus daunorubicin in older patients with newly diagnosed secondary acute myeloid leukemia. J Clin Oncol. 2018;36(26):2684-2692.