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. 2023 May 12;13(1):77.
doi: 10.1038/s41408-023-00835-5.

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

Claudia Sargas  1 , Rosa Ayala  2 , María J Larráyoz  3 , María C Chillón  4 , Eduardo Rodriguez-Arboli  5 , Cristina Bilbao  6 , Esther Prados de la Torre  7 , David Martínez-Cuadrón  8   9 , Rebeca Rodríguez-Veiga  8 , Blanca Boluda  8 , Cristina Gil  10 , Teresa Bernal  11 , Juan Bergua  12 , Lorenzo Algarra  13 , Mar Tormo  14 , Pilar Martínez-Sánchez  2 , Elena Soria  5 , Josefina Serrano  7 , Juan M Alonso-Dominguez  15 , Raimundo García  16 , María Luz Amigo  17 , Pilar Herrera-Puente  18 , María J Sayas  19 , Esperanza Lavilla-Rubira  20 , Joaquín Martínez-López  2 , María J Calasanz  3 , Ramón García-Sanz  4 , José A Pérez-Simón  5 , María T Gómez Casares  6 , Joaquín Sánchez-García  7 , Eva Barragán #  9   21 , Pau Montesinos #  22   23 ; PETHEMA cooperative study group
Collaborators, Affiliations

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

Claudia Sargas et al. Blood Cancer J. .

Abstract

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.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1. Risk categories distribution in the global cohort and according age and sex.
A 2017 ELN and B 2022 ELN. Green section: Favorable risk category; Yellow section: intermediate risk category and Red section: Adverse risk category. N = 546 intensively treated patients.
Fig. 2
Fig. 2. Outcomes of patients according to ELN risk categories.
A 2017 ELN and B 2022 ELN.
Fig. 3
Fig. 3
Sankey diagram comparing 2017 ELN and 2022 ELN risk categories.
Fig. 4
Fig. 4
Outcomes of patients according to the proposed refinement of the 2022 ELN risk categories.
Fig. 5
Fig. 5. Outcomes of MDS mutated patients.
A According to the number of mutated genes and B regarding intermediate and adverse 2022 ELN risk groups. MDS myelodysplasia-related genes.
See this image and copyright information in PMC

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