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. 2023 Feb 23;15(5):1425.
doi: 10.3390/cancers15051425.

Evolving Risk Classifications in AML in a Real-Life Scenario: After Changes upon Changes, Is It More and More Adverse?

Clara Aparicio-Pérez  1 , Esther Prados de la Torre  2 , Joaquin Sanchez-Garcia  1   2   3 , Carmen Martín-Calvo  1   2 , Carmen Martínez-Losada  1   2 , Javier Casaño-Sanchez  1   2 , Juana Serrano-López  4 , Josefina Serrano  1   2
Affiliations

Evolving Risk Classifications in AML in a Real-Life Scenario: After Changes upon Changes, Is It More and More Adverse?

Clara Aparicio-Pérez et al. Cancers (Basel). .

Abstract

Acute myeloid leukemia (AML) is a heterogeneous disease classified into three risk categories (favorable, intermediate and adverse) with significant differences in outcomes. Definitions of risk categories evolve overtime, incorporating advances in molecular knowledge of AML. In this study, we analyzed the impacts of evolving risk classifications in 130 consecutive AML patients in a single-center real-life experience. Complete cytogenetic and molecular data were collected using conventional qPCR and targeted Next Generation Sequencing (NGS). Five-year OS probabilities were consistent among all classification models (roughly 50-72%, 26-32% and 16-20% for favorable, intermediate and adverse risk groups, respectively). In the same way, the medians of survival months and prediction power were similar in all models. In each update, around 20% of patients were re-classified. The adverse category consistently increased over time (31% in MRC, 34% in ELN2010, 50% in ELN2017), reaching up to 56% in the recent ELN2022. Noteworthily, in multivariate models, only age and the presence of TP53 mutations remained statistically significant. With updates in risk-classification models, the percentage of patients assigned to the adverse group is increasing, and so will the indications for allogeneic stem cell transplantation.

Keywords: European Leukemia Net; TP53 mutations; acute myeloid leukemia; risk classifications.

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Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

Figure 1
Figure 1
Genetic entities defining in the ELN2022 risk stratification.
Figure 2
Figure 2
Number of molecular and cytogenetic risk defining alteration according to ELN2022 and distribution acrooss ELN2022 prognostic risk group.
Figure 3
Figure 3
Sankey diagram showing evolving re-classifications from MRC to ELN2022 stratification. Orange: favorable risk; green: intermediate risk; violet: adverse risk; blue: no classified.
Figure 4
Figure 4
Overall survival probability for the entire cohort (n = 130) according to the evolving risk classifications.
Figure 5
Figure 5
Overall survival probability for intensively treated patients (n = 87) according to the evolving risk classifications.
Figure 6
Figure 6
Overall survival probability for the entire cohort (n = 130) according to the ELN2022 high-risk group defined by the presence of TP53 mutation.
See this image and copyright information in PMC

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