Andrew Wei, MBBS, PhD, FRACP, FRCPA, from the Alfred Hospital and Monash University, Melbourne, Australia, discusses his highlights from the International Symposium on Acute Leukemias (ISAL) 2017 in Munich, Germany. He was particularly interested in a session on the complexity of acute myeloid leukemia (AML) focusing on aspects of its molecular biology, particularly clonal variation and clonal evolution. Dr Wei describes how the constantly evolving and changing clonal population means that multiple diseases need to be targeted in the same patient, which can be likened to trying to hit a moving target. Two main approaches came out of this discussion. Targeted therapy focused on a single molecule is unlikely to result in substantial long-term benefits because it only affects a small proportion of leukemia, and may allow resistance and evolution of another clone not susceptible to the drug. On the other hand, non-targeted approaches aim to modulate more fundamental processes not dependent on specific mutations and are therefore less likely to lead to drug resistance due to clonal evolution. Dr Wei concludes that it will be interesting to see which of these approaches, targeted or non-targeted, with be more successful.

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