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Proposed Modifications to Prognostic Classification of AML Patients Treated With Intensive Chemotherapy Based on

Joseph Brandwein1, David Page1, Elena Liew1

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A new acute myeloid leukemia (AML) risk classification improves prognostic discrimination. This revised system better predicts outcomes, especially after allogeneic stem cell transplant (HSCT), but advanced risk patients still need better therapies.

Keywords:
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Area of Science:

  • Hematology
  • Oncology
  • Genetics

Background:

  • The European LeukemiaNet (ELN) 2022 classification stratifies acute myeloid leukemia (AML) risk.
  • Optimal post-remission therapy, including allogeneic stem cell transplant (HSCT), is crucial for improving outcomes.

Purpose of the Study:

  • To evaluate the outcomes of newly diagnosed AML patients treated with intensive chemotherapy (IC).
  • To develop a refined prognostic scoring system incorporating HSCT into post-remission strategies.

Main Methods:

  • Retrospective analysis of AML patients treated with IC at a single center (2018-2024).
  • Evaluation of complete remission (CR) rates, HSCT utilization, overall survival (OS), and relapse-free survival (RFS).
  • Development of a transplant-adjusted prognostic scoring system based on ELN risk, mutations (e.g., RUNX1, TP53), and cytogenetics.

Main Results:

  • Complete remission (CR) rates did not differ significantly between ELN2022 favorable and intermediate risk groups.
  • High rates of HSCT in CR1 were observed for intermediate (81%) and adverse (85%) risk patients.
  • Overall survival (OS) was significantly worse in ELN adverse risk patients due to lower CR and higher relapse rates.
  • Within the adverse risk group, RUNX1 mutations conferred a better OS than other myelodysplasia-related mutations or adverse cytogenetics without RUNX1.
  • TP53 mutated patients exhibited the worst outcomes.
  • The novel prognostic model stratified patients into good (78% 5-year OS), intermediate (54%), poor (22%), and very poor (0%) risk groups.

Conclusions:

  • The revised classification demonstrates superior prognostic discrimination compared to ELN2022, particularly for intermediate risk patients undergoing HSCT.
  • Results for ELN adverse risk patients remain suboptimal, highlighting the need for improved therapeutic strategies.
  • The integrated approach, accounting for HSCT, refines risk stratification in AML management.