BLOG: ‘It’s easier than you think’ to teach genomic alterations in AML
Key takeaways:
- Genomic alterations are key to risk-stratifying patients, choosing therapy and monitoring response.
- Most fellows and APPs appreciate a clinician dedicating time to teach about genomic data.
I recently was invited to give a presentation about genomic alterations in AML at the 2024 ASTCT Clinical Education Conference for advanced practice providers, nurses and fellows.
I was pleased to have the opportunity to discuss this topic — not only to highlight some “high-yield” genomic findings APPs and fellows should be aware of as they are working up and treating patients with AML, but also to explain how to interpret genomic tests going forward so they can better understand their patients’ test results and adapt to the always-evolving role of genomics in AML.
Genomic alterations in AML are key to risk-stratifying patients, choosing appropriate therapy and monitoring disease response. The topic can be daunting to those just entering the field due to the complexity of the testing modalities and nomenclature, and many programs lack formal training in how to interpret these important genomic tests.
When I work with fellows and APPs, I set aside some teaching time dedicated to genomic and other molecular tests. We briefly review the high-yield mutations, rearrangements and karyotype results (ie, those that can change management), but we spend the most time on the fundamentals of how the tests are performed and how to interpret result reports.
Over the course of a few sessions, we review how to interpret a variety of genomic tests and reports:
Each of these tests has its own conventions for reporting findings, and providing trainees with the general structure and key nomenclature terms helps establish a shared vocabulary.
Gene mutation reporting is relatively simple, and trainees rapidly grasp how to identify specific molecular changes in reports.
Conventional karyotype and FISH nomenclature is much more complex. I focus on the more common and straightforward structural alterations, and I advise trainees to do what I do when I come across unfamiliar nomenclature — ask a cytogeneticist (or Dr. Google).
After reviewing the terminology, we work through a couple cases together step-by-step, before I ask them to start explaining reports to me.
Trainees typically grasp the concepts quickly. We reinforce and expand their base of genomic alteration knowledge during daily rounds, where I ask them to incorporate new results into their assessments and plans for their patients.
I have found that the fellows and APPs I have worked with have appreciated a clinician dedicating some teaching time expressly for genomic data, and I would encourage other attendings who are not already doing so to consider incorporating genomic testing into their teaching repertoire.
It’s an area of AML — and really all of oncology, and even beyond — that continues to expand, and, as I tell the (sometimes dubious) fellows and APPs, it’s easier than you think!
For more information:
Ryan B. Day, MD, PhD, is a medical oncologist at Siteman Cancer Center and instructor in the department of medicine at Washington University in St. Louis. He can be reached at ryanday@wustl.edu.
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