Transforming Acute Myeloid Leukemia Care Through Precision Medicine: Integrating Genomic Profiling, Measurable Residual Disease, and Targeted Therapies

Acute myeloid leukemia (AML) is a biologically heterogeneous and clinically aggressive hematologic malignancy, with outcomes that remain poor for many older adults and patients with adverse-risk disease. Advances in cytogenetics and next-generation sequencing have uncovered actionable lesions (e.g., FLT3, IDH1/2, NPM1) and enabled biomarker-driven risk stratification and therapy selection. Since 2017, multiple targeted and antibody-drug conjugate approaches—often combined with intensive chemotherapy or hypomethylating agents—have improved remission rates in molecularly defined subsets. Measurable residual disease (MRD) assessment using multiparameter flow cytometry and molecular assays is increasingly used to refine post-remission decisions, including transplantation and maintenance strategies, but is constrained by assay variability, clonal hematopoiesis, and limited evidence for MRD-directed interventions. This narrative review synthesizes the evolving genomic landscape, guideline-endorsed targeted therapies, and investigational strategies in AML, and provides a practical framework that integrates genomic profiling, MRD-informed decision-making, and algorithmic treatment pathways while highlighting real-world barriers to implementation and equity.