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Abstract：
Risk stratification in acute myeloid leukemia (AML) remains principle in survival prognostication and treatment selection. The 2022 European LeukemiaNet (ELN) recommendations were recently published, with notable updates to risk group assignment. The complexity of risk stratification and comparative outcomes between the 2022 and 2017 ELN guidelines remains unknown. This comparative analysis evaluated outcomes between the 2017 and 2022 ELN criteria in patients enrolled within the multicenter Beat AML cohort. Five hundred thirteen patients were included. Most patients had 1 or 2 ELN risk-defining abnormalities. In patients with ≥2 ELN risk-defining mutations, 44% (n = 132) had mutations spanning multiple ELN risk categories. Compared with ELN 2017 criteria, the updated ELN 2022 guidelines changed the assigned risk group in 15% of patients, including 10%, 26%, and 6% of patients categorized as being at ELN 2017 favorable-, intermediate-, and adverse-risk, respectively. The median overall survival across ELN 2022 favorable-, intermediate-, and adverse-risk groups was not reached, 16.8, and 9.7 months, respectively. The ELN 2022 guidelines more accurately stratified survival between patients with intermediate- or adverse-risk AML treated with induction chemotherapy compared with ELN 2017 guidelines. The updated ELN 2022 guidelines better stratify survival between patients with intermediate- or adverse-risk AML treated with induction chemotherapy. The increased complexity of risk stratification with inclusion of additional cytogenetic and molecular aberrations necessitates clinical workflows simplifying risk stratification.
摘要：
急性髓性白血病（AML）的风险分层仍然是生存预后和治疗选择的原则。最近发布了2022年欧洲白血病网（ELN）建议，对风险组分配进行了显著更新。2022年和2017年ELN指南之间风险分层和比较结果的复杂性仍然未知。这项比较分析评估了2017年和2022年ELN标准在多中心BeatAML队列中招募的患者的结果。包括五十三名患者。大多数患者有一个（36％[N=183]）或两个（31％[N=159]）ELN风险定义异常。在具有两个或更多个ELN风险定义突变的患者中（58％[N=297]），44％（N=132）的突变跨越多个ELN风险类别。与ELN2017标准相比，更新的ELN2022指南改变了15%(N=75)患者的分配风险组，包括10%(N=16/160)，26%（N=29/112），和6%(N=13/224)的ELN2017有利，中间,和不良风险患者。ELN2022的中位操作系统有利，中间,未达到不良风险组（估计5年OS：53％[标准误差：0.06％]），16.8（95%CI：11-48）和9.7（95%CI：8.3-10.8）个月，分别。ELN2022指南更准确地对接受IC治疗的中度或不良风险AML患者之间的生存率进行了分层（HR：1.58[95％CI：1.12-2.25]，p值：0.01）与ELN2017指南（HR1.27[95%CI：0.88-1.85]，p值：0.20）。更新的ELN2022指南更好地分层生存，即在接受IC治疗的中度或不良风险AML患者之间。风险分层的复杂性增加，包括额外的细胞遗传学和分子畸变，需要临床工作流程简化风险分层。
