**6. Conclusions**

A basis for every therapeutic decision in AML cases should be provided by a multimodal diagnostic approach. The optimal therapeutic conditions are based on exact classification and prognosis of the AML subtype at diagnosis and to delineation of sensitive markers for MRD studies during the complete hematologic remission. MRD methods have many potential applications in the clinical management of patients with acute leukemia. Today, a multimodal diagnostic approach which combines different diagnostic techniques is needed to meet these requirements. The diagnostic process is becoming more demanding with respect to experience, time and costs due to the expansion of methods and algorithms, which guide the diagnostic procedure from basic to more specific methods and which finally lead to results that are essential for modern diagnostics and therapeutic concepts. There are numerous overlaps between different diagnostic methods. These can be used for optimal pathways in the complex diagnostic proceedings and for validation of the results of single methods, which can be summarized in diagnostic algorithms. Basic morphological and cytochemical analyses performed in our study group established the lineage assignment of the blasts cells in 68 (88.3%) patients. Routine immunophenotyping improved the diagnosis in 12 (15.5%) more cases. Molecular analyses enabled 23.7% of the cases from our study to be classified in the adequate genetic entities of AML with different prognosis requiring different therapeutical approach.

The applied multimodal diagnostic approach consisted of minimal number of cytomorphological, cytochemistry, immunological and molecular analyses enables improved and more precise diagnosis and clinical stratification in 38.2% acute leukemia patients from our study. Moreover, when we correlate those results with the results obtained from the analyses of the EKOG performance status and the incidence of the serious comborbidities in our study group, an additional 12.5% of the patients were stratified to a different risk adapted therapy.

Our initial results are consistent with literature data and indicate that our applied multimodal diagnostic approach improved the diagnosis of the specific genetic entities of AML in which specific treatment approach is indicated and allows individual clinical stratification in treatment protocols of the patients.
