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Leucemia mieloide aguda: una actualización completa

Maria Jose Garcia-Rodriguez1, Yorman Flores1, Jose Salinas2

  • 1Hematopoietic Stem Cell Transplantation Program. Hematology Department Pontificia Universidad Católica de Chile Red de Salud Christus UC.

Current opinion in hematology
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Resumen

Los avances recientes en la leucemia mieloide aguda (LMA) se centran en las alteraciones genéticas para un diagnóstico preciso y terapias dirigidas. La monitorización medible de la enfermedad residual (MRD, por sus siglas en inglés) guía el tratamiento, mejorando los resultados para los pacientes con LMA.

Palabras clave:
Leucemia mieloide agudaTrasplante de células madre alogénicastratamiento dirigido

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Área de la Ciencia:

  • Hematología
  • En el campo de la oncología
  • Genética molecular

Sus antecedentes:

  • La leucemia mieloide aguda (LMA) es un tumor hematológico complejo con diversos fundamentos genéticos.
  • Los últimos años han visto avances rápidos en la comprensión del paisaje molecular de la LMA y el desarrollo de nuevas estrategias terapéuticas.

Objetivo del estudio:

  • Para sintetizar los avances recientes en el diagnóstico, la clasificación y el tratamiento de la LMA a partir de 2025.
  • Proporcionar una perspectiva actualizada para los médicos e investigadores sobre el manejo de la LMA.

Principales métodos:

  • Revisión de la literatura reciente y los hallazgos clínicos.
  • Análisis de las clasificaciones actualizadas de la OMS y la CPI.
  • Síntesis de datos sobre perfiles moleculares y terapias dirigidas.

Principales resultados:

  • Las nuevas clasificaciones hacen hincapié en las alteraciones genéticas para el subtipo preciso de LMA.
  • El perfil molecular mejora la estratificación del riesgo y pone de relieve el papel de la enfermedad residual mensurable.
  • Los agentes dirigidos (FLT3, IDH1/ 2, inhibidores de la menina) ofrecen nuevas opciones para grupos específicos de pacientes, incluidos los que no son aptos para la quimioterapia intensiva o con enfermedad recurrente.

Conclusiones:

  • Las ideas genómicas y las terapias novedosas están transformando el manejo de la LMA hacia la medicina personalizada.
  • La evolución de las estrategias posremisión, incluidas las decisiones guiadas por MRD y las terapias de mantenimiento, tiene como objetivo mejorar el control de la enfermedad a largo plazo.
  • Los tratamientos emergentes como la terapia con células CAR-T son prometedores para el futuro tratamiento de la LMA.