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. 2023 Jun 23:10:1165445.
doi: 10.3389/fmed.2023.1165445. eCollection 2023.

The latest edition of WHO and ELN guidance and a new risk model for Chinese acute myeloid leukemia patients

Xiaoning Wang #  1 , Jie Wang #  1 , Suhua Wei  1 , Juan Zhao  1 , Beibei Xin  2 , Guoqing Li  2 , Jing Zhao  1 , Di Wu  1 , Minna Luo  1 , Sijie Zhao  1 , Ying Chen  1 , Haibo Liu  1 , Hailing Zhang  1 , Jingcheng Wang  1 , Wenjuan Wang  1 , Huaiyu Wang  1 , Hui Xiong  2 , Pengcheng He  1   3
Affiliations

The latest edition of WHO and ELN guidance and a new risk model for Chinese acute myeloid leukemia patients

Xiaoning Wang et al. Front Med (Lausanne). .

Abstract

Objective: Diagnosis classification and risk stratification are crucial in the prognosis prediction and treatment selection of acute myeloid leukemia (AML). Here, we used a database of 536 AML patients to compare the 4th and 5th WHO classifications and the 2017 and 2022 versions of ELN guidance.

Methods: AML patients were classified according to the 4th and 5th WHO classifications, as well as the 2017 and 2022 versions of the European LeukemiaNet (ELN) guidance. Kaplan-Meier curves with log-rank tests were used for survival analysis.

Results: The biggest change was that 25 (5.2%), 8 (1.6%), and 1 (0.2%) patients in the AML, not otherwise specified (NOS) group according to the 4th WHO classification, were re-classified into the AML-MR (myelodysplasia-related), KMT2A rearrangement, and NUP98 rearrangement subgroups based on the 5th WHO classification. Referring to the ELN guidance, 16 patients in the favorable group, six patients in the adverse group, and 13 patients in the intermediate group based on the 2017 ELN guidance were re-classified to the intermediate and adverse groups based on the 2022 ELN guidance. Regrettably, the Kaplan-Meier curves showed that the survival of intermediate and adverse groups could not be distinguished well according to either the 2017 or 2022 ELN guidance. To this end, we constructed a risk model for Chinese AML patients, in which the clinical information (age and gender), gene mutations (NPM1, RUNX1, SH2B3, and TP53), and fusions (CBFB::MYH11 and RUNX1::RUNX1T1) were included, and our model could help divide the patients into favorable, intermediate, and adverse groups.

Conclusion: These results affirmed the clinical value of both WHO and ELN, but a more suitable prognosis model should be established in Chinese cohorts, such as the models we proposed.

Keywords: European Leukemia Net; World Health Organization; acute myeloid leukemia; prognosis; risk model.

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Conflict of interest statement

BX, GL, and HX were employed by Shanghai Yuanqi Biomedical Technology Co., Ltd. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
The classification of AML patients based on the WHO and ELN guidance. (A) Sankey diagram demonstrated the relationship between AML patients' subtypes defined in the 4th and 5th WHO classifications. (B) Sankey diagram demonstrated the relationship between AML patients' subtypes defined in the 2017 ELN and 2022 ELN guidance (WHO, World Health Organization; ELN, European Leukemia Network; AML, acute myeloid leukemia; MECOM-r, MECOM rearrangement; KMT2A-r, KMT2A rearrangement; NUP98-r, NUP98 rearrangement; AML-MRC, AML with myelodysplasia-related changes; AML-MR, AML, myelodysplasia-related; NOS, not otherwise specified).
Figure 2
Figure 2
Assessment of the value of 4th and 5th WHO classifications on the PFS and OS of AML patients. Kaplan–Meier curves were used to assess the OS and PFS of patients of the favorable, intermediate, and adverse groups according to the 4th (A) and 5th WHO classifications [(B); WHO, World Health Organization; AML, acute myeloid leukemia; MECOM-r, MECOM rearrangement; KMT2A-r, KMT2A rearrangement; NUP98-r, NUP98 rearrangement; AML-MRC, AML with myelodysplasia-related changes; AML-MR, AML, myelodysplasia-related; NOS, not otherwise specified].
Figure 3
Figure 3
Assessment of the value of 2017 and 2022 ELN guidance on the PFS and OS of AML patients. Kaplan–Meier curves were used to assess the OS and PFS of patients of the favorable, intermediate, and adverse groups according to the 2017 (A) and 2022 (B) ELN guidance, together with transplantation [(C); ELN, European Leukemia Network; HCT, hematopoietic stem cell transplantation].
Figure 4
Figure 4
Establishment of the prognosis models for Chinese AML patients. (A) Kaplan–Meier curves were used to assess the PFS of patients of the favorable, intermediate, and adverse groups in both the training set and test set. (B) The nomogram model was applied to demonstrate the contributions of the selected factors to the 1-, 3-, and 5-year PFS probability. (C) Kaplan–Meier curves were used to assess the OS of patients of the favorable, intermediate, and adverse groups in both the training set and the test set. (D) The nomogram model was applied to demonstrate the contributions of the selected factors to the 1-, 3-, and 5-year OS probability.
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