Journal Article

Prognostic Impact of the AML60+ Score for Elderly Patients with Acute Myeloid Leukemia Treated with Hypomethylating Agents: A Retrospective Multicentric Analysis

Goede, Jeroen S., Silzle, Tobias, Graf, Lukas, Driessen, Christoph, Weber, Matthias, Gerth, Yannick, Mey, Ulrich J. M., Cathomas, Richard, Micheloud, Charlotte, Cogliatti, Sergio, Fuchs, Stefan, Lehmann, Thomas, Petermichl, Verena, Gobat, Katrin

2025

Overview

Background: The AML60+ score has been proposed for risk stratification in intensively treated elderly patients with acute myeloid leukemia (AML) or high-risk myelodysplastic neoplasms (MDS). Its prognostic impact in patients treated with hypomethylating agents (HMA) is unknown. Methods: Patients ≥ 60 years of age diagnosed with AML or MDS/AML according to ICC2022 were eligible for this retrospective and multicenter chart review if they had received at least one cycle of HMA-based treatment. Results: A cohort of 142 patients was analyzed. During follow-up (median 8 months), 114 patients died. The molecular Prognostic Score (mPRS) was available for 121 patients, the European Leukemia Net (ELN) 2022 classification for 117 patients, and the AML60+ for 105 patients. According to AML60+, 33 patients (31.4%) were classified as very poor risk, 36 (34.3%) as poor risk, and 34 (32.4%) as intermediate risk. Two patients (1.9%) were classified as favorable. Median overall survival (OS) was 21.7 months (mo) for the combined intermediate/favorable group, 7 mo for the poor risk group and 3 mo for the very poor risk group (p < 0.0001). Cox regression analysis (reference category: very poor) showed a significantly lower risk of death for both intermediate/favorable risk patients (HR 0.17, 95% CI 0.10–0.31, p < 0.001) and poor risk patients (HR 0.47, 95% CI 0.28–0.78, p = 0.004). The concordance score was 0.67 for AML60+, 0.60 for mPRS, and 0.58 for ELN2022. Conclusions: The AML60+ may represent a useful prognostic tool for elderly AML patients treated with HMA-based therapies. In particular, it could help to identify a group with a relatively favorable prognosis that is not clearly identified by the ELN2022 or the mPRS risk classification. However, analyses of larger cohorts are necessary to confirm our findings.

• Publisher: MDPI AG,MDPI
• Subject: Acute myeloid leukemia / Aged patients / Allografts / Cancer / Care and treatment / Chemotherapy / Classification / Comparative analysis / Cytogenetics / Disease / Health risk assessment / Hospitals / Leukemia / Medical research / Medicine, Experimental / Mutation / Myelodysplastic syndrome / Patients / Prognosis / Stem cell transplantation / Stem cells / Transplantation