Acute myeloid leukemia: a comprehensive update

Acute myeloid leukemia (AML) is a biologically diverse disease that has undergone significant transformation in recent years. The rapid pace of discovery in molecular genetics, disease classification, and therapeutic development has reshaped how we approach diagnosis and treatment. This review aims to provide a timely and relevant synthesis of these advances, offering clinicians and researchers an updated perspective on AML as of 2025.

The 2022 WHO and ICC classifications have shifted the diagnostic focus toward genetic alterations, allowing for more precise subtyping and personalized treatment decisions. Advances in molecular profiling have improved risk stratification and highlighted the importance of measurable residual disease (MRD) in guiding therapy. Targeted agents - such as fms-like tyrosine kinase 3 (FLT3), isocitrate dehydrogenase (IDH)1/2, and menin inhibitors - have broadened options for patients who are unfit for intensive chemotherapy or have relapsed disease. Postremission strategies are evolving, with increasing use of MRD-guided transplant decisions and maintenance therapies like sorafenib and oral azacitidine. While CAR-T cell therapy remains investigational in AML, early results are promising and support continued exploration.

The integration of genomic insights with emerging therapies is transforming AML management. These developments are paving the way toward more personalized care, improved outcomes, and new opportunities for long-term disease control and cure.