Genomics of acute myeloid leukemia

The acute myeloid leukemia (AML) genome has been the subject of intensive research over the past 4 decades. New technologies, enabling characterization of the AML genome at increased resolution, have revealed deeper layers of complexity that have provided insights into the biological basis of this disease, nominated targets for therapy, and identified biomarkers predictive of response to therapy or long-term prognosis. Still, our understanding of AML genomics is incomplete. Recent publications have demonstrated that whole genome sequencing of primary AML samples is feasible and can detect novel, clinically relevant mutations. New insights are emerging from this work, including the clonal heterogeneity of this disease and clonal evolution that occurs over time. Some of the novel mutations are highly recurrent (>20% of patients), but there appears to be a continuum of mutation frequency down to rare (<5%) or even singleton mutations that may be relevant for the biology of this disease. Large cohorts of well-annotated samples are needed to establish mutation frequencies, implicate biological pathways, and demonstrate genotype-phenotype correlations. Although many technical and logistical challenges must be overcome, the capacity of whole genome sequencing to detect all classes of inherited and acquired genetic abnormalities makes it an attractive candidate for development as a clinical diagnostic test.