TY - JOUR
T1 - Validation of the revised 2022 European LeukemiaNet risk stratification in adult patients with acute myeloid leukemia
AU - Ruhnke, Leo
AU - Bill, Marius
AU - Zukunft, Sven
AU - Eckardt, Jan-Niklas
AU - Schaefer, Silvia
AU - Stasik, Sebastian
AU - Hanoun, Maher
AU - Schroeder, Thomas
AU - Fransecky, Lars
AU - Steffen, Bjoern
AU - Krause, Stefan W.
AU - Scholl, Sebastian
AU - Hochhaus, Andreas
AU - Sauer, Tim
AU - Kraus, Sabrina
AU - Schaefer-Eckart, Kerstin
AU - Kaufmann, Martin
AU - Jost, Edgar
AU - Bruemmendorf, Tim
AU - Schliemann, Christoph
AU - Mikesch, Jan-Henrik
AU - Krug, Utz
AU - Haenel, Mathias
AU - Morgner, Anke
AU - Schaich, Markus
AU - Neubauer, Andreas
AU - Repp, Roland
AU - Niemann, Dirk
AU - Seggewiss-Bernhardt, Ruth
AU - Meinhardt, Achim
AU - Kullmer, Johannes
AU - Kaiser, Ulrich
AU - Blau, Wolfgang
AU - Kiani, Alexander
AU - Grigoleit, Goetz Ulrich
AU - Giagounidis, Aristoteles
AU - Schafer-Eckart, Kerstin
AU - Steffan, Bjorn
AU - Wurm, Alexander A.
AU - Altmann, Heidi
AU - Middeke, Jan Moritz
AU - Schetelig, Johannes
AU - Mueller-Tidow, Carsten
AU - Stoelzel, Friedrich
AU - Baldus, Claudia D.
AU - Platzbecker, Uwe
AU - Serve, Hubert
AU - Bornhaeuser, Martin
AU - Thiede, Christian
AU - Roellig, Christoph
N1 - Schäfer-Eckart: Department of Internal Medicine V, Nuremberg Hospital North, Paracelsus Medical University, Nuremberg, Germany
PY - 2025/3/25
Y1 - 2025/3/25
N2 - In 2022, the European LeukemiaNet (ELN) risk stratification for patients with acute myeloid leukemia (AML) has been updated. We aimed to validate the prognostic value of the 2022 ELN classification (ELN22) by evaluating 1570 patients with newly diagnosed AML (median age, 56 years) treated with cytarabine-based intensive chemotherapy regimens. Compared with 2017 ELN classification (ELN17), which allocated 595 (38%), 413 (26%), and 562 patients (36%) to the favorable-, intermediate-, and adverse-risk categories, ELN22 classified 575 (37%), 410 (26%), and 585 patients (37%) as favorable, intermediate, and adverse risk, respectively. Risk group allocation was revised in 340 patients (22%). Most patients were reclassified into the ELN22 intermediate- or ELN22 adverse-risk group. The allocation of patients according to the ELN22 risk categories resulted in a significantly distinct event-free survival (EFS), relapse-free survival, and overall survival (OS). Compared with ELN17, reallocation according to the ELN22 recommendations resulted in a significantly improved prognostic discrimination for OS (3-year area under the curve, 0.71 vs 0.67). In patients with ELN22 favorable-risk AML, co-occurring myelodysplasia-related (MR) gene mutations did not significantly affect outcomes. Within the ELN22 adverse-risk group, we observed marked survival differences across mutational groups (5-year OS rate of 21% and 3% in patients with MR gene mutations and TP53 mutations, respectively). In patients harboring MR gene mutations, EZH2-, STAG2-, and ZRSR2-mutated patients showed an intermediate-like OS. In patients with secondary AML and those who underwent allogeneic hematopoietic cell transplantation, EFS and OS significantly differed between ELN22 risk groups, whereas the prognostic abilities of ELN17 and ELN22 classifications were similar. In conclusion, ELN22 improves prognostic discrimination in a large cohort of intensively treated patients with AML. Given the heterogeneous outcome in patients with MR gene alterations, ranging between those of intermediate and adverse risk patients, we suggest re-evaluation of risk allocation in these patients.
AB - In 2022, the European LeukemiaNet (ELN) risk stratification for patients with acute myeloid leukemia (AML) has been updated. We aimed to validate the prognostic value of the 2022 ELN classification (ELN22) by evaluating 1570 patients with newly diagnosed AML (median age, 56 years) treated with cytarabine-based intensive chemotherapy regimens. Compared with 2017 ELN classification (ELN17), which allocated 595 (38%), 413 (26%), and 562 patients (36%) to the favorable-, intermediate-, and adverse-risk categories, ELN22 classified 575 (37%), 410 (26%), and 585 patients (37%) as favorable, intermediate, and adverse risk, respectively. Risk group allocation was revised in 340 patients (22%). Most patients were reclassified into the ELN22 intermediate- or ELN22 adverse-risk group. The allocation of patients according to the ELN22 risk categories resulted in a significantly distinct event-free survival (EFS), relapse-free survival, and overall survival (OS). Compared with ELN17, reallocation according to the ELN22 recommendations resulted in a significantly improved prognostic discrimination for OS (3-year area under the curve, 0.71 vs 0.67). In patients with ELN22 favorable-risk AML, co-occurring myelodysplasia-related (MR) gene mutations did not significantly affect outcomes. Within the ELN22 adverse-risk group, we observed marked survival differences across mutational groups (5-year OS rate of 21% and 3% in patients with MR gene mutations and TP53 mutations, respectively). In patients harboring MR gene mutations, EZH2-, STAG2-, and ZRSR2-mutated patients showed an intermediate-like OS. In patients with secondary AML and those who underwent allogeneic hematopoietic cell transplantation, EFS and OS significantly differed between ELN22 risk groups, whereas the prognostic abilities of ELN17 and ELN22 classifications were similar. In conclusion, ELN22 improves prognostic discrimination in a large cohort of intensively treated patients with AML. Given the heterogeneous outcome in patients with MR gene alterations, ranging between those of intermediate and adverse risk patients, we suggest re-evaluation of risk allocation in these patients.
KW - Mutations
KW - Recommendations
KW - Intermediate
KW - Association
KW - Management
KW - Diagnosis
KW - Impact
KW - Aml
UR - https://www.webofscience.com/api/gateway?GWVersion=2&SrcApp=pmu_pure&SrcAuth=WosAPI&KeyUT=WOS:001458297000001&DestLinkType=FullRecord&DestApp=WOS_CPL
U2 - 10.1182/bloodadvances.2024013304
DO - 10.1182/bloodadvances.2024013304
M3 - Original Article
C2 - 39504561
SN - 2473-9529
VL - 9
SP - 1392
EP - 1404
JO - BLOOD ADVANCES
JF - BLOOD ADVANCES
IS - 6
ER -