Journal Article

Comparison of the 2022 and 2017 European LeukemiaNet risk classifications in a real-life cohort of the PETHEMA group

Serrano, Josefina, Herrera-Puente, Pilar, Chillón, María C, Bilbao, Cristina, Larráyoz, María J, Prados de la Torre, Esther, Boluda, Blanca, Martínez-López, Joaquín, Bergua, Juan, Rodríguez-Veiga, Rebeca, Algarra, Lorenzo, Alonso-Dominguez, Juan M, García, Raimundo, Bernal, Teresa, Sargas, Claudia, Amigo, María Luz, Martínez-Sánchez, Pilar, Sayas, María J, Sánchez-García, Joaquín, Tormo, Mar, Soria, Elena, Pérez-Simón, José A, Ayala, Rosa, Martínez-Cuadrón, David, Gil, Cristina, Lavilla-Rubira, Esperanza, Rodriguez-Arboli, Eduardo, García-Sanz, Ramón, Montesinos, Pau, Calasanz, María J, Gómez Casares, María T, Barragán, Eva

2023

Overview

Next-Generation Sequencing is needed for the accurate genetic risk stratification of acute myeloid leukemia according to European LeukemiaNet (ELN) guidelines. We validated and compared the 2022 ELN risk classification in a real-life cohort of 546 intensively and 379 non-intensively treated patients. Among fit patients, those aged ≥65 years old showed worse OS than younger regardless risk classification. Compared with the 2017 classification, 14.5% of fit patients changed the risk with the 2022 classification, increasing the high-risk group from 44.3% to 51.8%. 3.7% and 0.9% FLT3-ITD mutated patients were removed from the favorable and adverse 2017 categories respectively to 2022 intermediate risk group. We suggest that midostaurin therapy could be a predictor for 3 years OS (85.2% with vs. 54.8% without midostaurin, P = 0.04). Forty-seven (8.6%) patients from the 2017 intermediate group were assigned to the 2022 adverse-risk group as they harbored myelodysplasia (MDS)-related mutations. Patients with one MDS-related mutation did not reach median OS, while patients with ≥2 mutations had 13.6 months median OS (P = 0.002). Patients with TP53 ± complex karyotype or inv(3) had a dismal prognosis (7.1 months median OS). We validate the prognostic utility of the 2022 ELN classification in a real-life setting providing supportive evidences to improve risk stratification guidelines.

• Publisher: Springer Nature B.V
• Subject: Classification / Mutation