**6. Future direction**

NGS technologies have made a huge impact in research and clinical diagnostics. It has expanded genes that are causing malignancies and will soon replace routine testing for single-gene mutations with NGS-based gene panel diagnostics. The information will be acquired from NGS assay and will play a role in personalized medicine. This will provide the basis for more comprehensive knowledge data banks that can serve as valuable tools to advance individualized treatment approaches [82]. In addition, we also recorded rapid technical advances that allow for more accurate MRD assessment and started to offer the possibility of capturing leukemia heterogeneity at the single-cell level. NGS will serve as a powerful tool for gaining deeper insights into leukemia stem cell phenotypes, signaling pathways, and function [83]. Finally, population based information will be used in the future to tailor NGS panels, and useful prognostic and predictive markers can be identified. Novel targeted therapeutic approaches hold promise for improving patient outcomes, but it will be important that genomic-based outcome prediction systems stay flexible and adaptable to reflect advances in treatment and changes in disease monitoring.

AML biology is rapidly expanding, and there is a great need to apply knowledge to the clinical context as soon as possible in order to improve the outcomes of our patients. Clinical outcomes will improve to enhance the clinical care of patients with AML, especially older patients for whom clinical outcomes have improved little over the past several decades. Instead of delaying introduction of novel agents to the setting of relapsed/ refractory disease, we propose consideration of frontline treatment with targeted agents either alone or in combination with chemotherapy, in the context of multicenter and/or cooperative group clinical trials, when available.
