Comparison of the 2022 and 2017 European LeukemiaNet risk classifications in a real-life cohort of the PETHEMA group
Claudia Sargas, Rosa Ayala, María José Larráyoz, María C. Chillón, Eduardo Rodríguez‐Arbolí, Cristina Bilbao, Esther Prados de la Torre, David Martínez‐Cuadrón, Rebeca Rodríguez‐Veiga, Blanca Boluda, Cristina Gil, Teresa Bernal, Juan Bergua, Lorenzo Algarra, Mar Tormo, Pilar Martínez‐Sánchez, Elena Soria, Josefina Serrano, Juan Manuel Alonso‐Domínguez, Raimundo García, María Luz Amigo, Pilar Herrera‐Puente, María José Sayas, Esperanza Lavilla, Joaquín Martínez‐López, Marı́a José Calasanz, Ramón García‐Sánz, José Antonio Pérez‐Simón, María Teresa Gómez‐Casares, Joaquín Sánchez‐García, Eva Barragán, Pau Montesinos, PETHEMA cooperative study group, Esther Prados de la Torre
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.