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. 2025 Aug 14;17(16):2658.
doi: 10.3390/cancers17162658.

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

Verena Petermichl  1 , Stefan Fuchs  2 , Matthias Weber  3 , Katrin Gobat  4 , Charlotte Micheloud  4 , Lukas Graf  5 , Yannick Gerth  5 , Jeroen S Goede  6 , Thomas Lehmann  1   3 , Christoph Driessen  1 , Ulrich J M Mey  7 , Richard Cathomas  7 , Sergio Cogliatti  3 , Tobias Silzle  1   7
Affiliations

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

Verena Petermichl et al. Cancers (Basel). .

Abstract

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.

Keywords: AML60+; ELN2022; acute myeloid leukemia; hypomethylating agents; mPRS; prognostication; venetoclax.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Distribution of the risk groups according to ELN2022 (A), mPRS (B), and AML60+ (C).
Figure 2
Figure 2
River plot of patients for whom all three scores were available (n = 102).
Figure 3
Figure 3
Kaplan–Meier estimates of overall survival by the single factors according to AML60+. (A) age, (B) sex, (C) white blood cell count, (D) monosomal karyotype, (E) mutated ASXL1, (F) mutated DNMT3A, (G) FLT3-ITD mutation, (H) mutated TP53 and (I) mutated RUNX1.
Figure 4
Figure 4
Kaplan–Meier estimates of overall survival for patients treated with either HMA or HMA + Ven by ELN2022, n = 117 (A), AML60+, n = 105 (B), and mPRS, n = 121 (C).
Figure 5
Figure 5
Kaplan–Meier estimates for overall survival for patients treated with HMA + Ven by ELN2022, n = 81 (A), AML60+, n = 70 (B), and mPRS, n = 83 (C).
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