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

backgroundAcute 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 identified actionable molecular lesions, including FLT3, IDH1/2, and NPM1, enabling biomarker-driven risk stratification and more individualized therapeutic approaches. SUMMARY: Since 2017, multiple targeted therapies and antibody-drug conjugates, often combined with intensive chemotherapy or hypomethylating agents, have improved remission rates in molecularly defined AML subsets. Measurable residual disease (MRD) assessment using multiparameter flow cytometry and molecular assays is increasingly incorporated into post-remission evaluation to inform decisions regarding transplantation and maintenance therapy. However, its clinical utility remains limited by assay variability, interference from clonal hematopoiesis, and the lack of robust evidence supporting MRD-directed interventions. This narrative review synthesizes the evolving genomic landscape of AML, current guideline-endorsed targeted therapies, and emerging investigational strategies, while outlining a practical framework that integrates genomic profiling, MRD-informed decision-making, and algorithmic treatment pathways. KEY MESSAGES: Precision medicine is reshaping AML management through genomic classification, targeted therapies, and evolving MRD applications. A practical treatment framework that incorporates molecular profiling and post-remission risk assessment may improve clinical decision-making, although real-world barriers to implementation and issues of equity remain important challenges.