Prognostic impact of the ELN2017 risk classification in patients with AML receiving allogeneic transplantation

Area of Science:

• Hematology
• Oncology
• Stem Cell Transplantation

Background:

• The 2017 European LeukemiaNet (ELN) classification stratifies acute myeloid leukemia (AML) patients into risk groups based on cytogenetic and molecular markers.
• Prognostic significance of the ELN 2017 classification specifically after allogeneic hematopoietic stem cell transplantation (HSCT) remains understudied.

Purpose of the Study:

• To evaluate the prognostic impact of the ELN 2017 risk classification in AML patients undergoing allogeneic HSCT.
• To assess the role of specific genetic aberrations (TP53 mutations, monosomal karyotype) and measurable residual disease (MRD) in this context.

Main Methods:

• Risk stratification of 234 AML patients undergoing allogeneic HSCT using the ELN 2017 criteria.
• Analysis of prognostic significance, relapse rates, and overall survival based on ELN 2017 risk groups.
• Subgroup analyses for TP53 mutations, monosomal karyotype, and pre-HSCT MRD status (assessed by digital droplet PCR).

Main Results:

• The ELN 2017 classification significantly stratified patients into favorable, intermediate, and adverse risk groups with distinct prognoses post-HSCT.
• Patients with monosomal karyotype or TP53 mutations showed increased relapse rates, even within the adverse-risk group.
• Measurable residual disease (MRD) positivity before HSCT was associated with impaired prognosis, similar to the ELN 2017 adverse risk group.

Conclusions:

• The ELN 2017 classification retains prognostic value in AML patients undergoing allogeneic HSCT.
• TP53 mutations, monosomal karyotype, and pre-HSCT MRD positivity indicate a particularly dismal prognosis, underscoring the need for intensified monitoring and treatment strategies.