Validation of the revised 2022 European LeukemiaNet risk stratification in adult patients with acute myeloid leukemia
Abstract: In 2022, the European LeukemiaNet (ELN) risk stratification for patients with acute myeloid leukemia (AML) has been updated. We aimed to validate the prognostic value of the 2022 ELN classification (ELN22) by evaluating 1570 patients with newly diagnosed AML (median age, 56 years) treated...
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Elsevier
2025-03-01
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| Series: | Blood Advances |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2473952924006438 |
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| author | Leo Ruhnke Marius Bill Sven Zukunft Jan-Niklas Eckardt Silvia Schäfer Sebastian Stasik Maher Hanoun Thomas Schroeder Lars Fransecky Björn Steffen Stefan W. Krause Sebastian Scholl Andreas Hochhaus Tim Sauer Sabrina Kraus Kerstin Schäfer-Eckart Martin Kaufmann Edgar Jost Tim Brümmendorf Christoph Schliemann Jan-Henrik Mikesch Utz Krug Mathias Hänel Anke Morgner Markus Schaich Andreas Neubauer Roland Repp Dirk Niemann Ruth Seggewiss-Bernhardt Achim Meinhardt Johannes Kullmer Ulrich Kaiser Wolfgang Blau Alexander Kiani Götz Ulrich Grigoleit Aristoteles Giagounidis Alexander A. Wurm Heidi Altmann Jan Moritz Middeke Johannes Schetelig Carsten Müller-Tidow Friedrich Stölzel Claudia D. Baldus Uwe Platzbecker Hubert Serve Martin Bornhäuser Christian Thiede Christoph Röllig |
| author_facet | Leo Ruhnke Marius Bill Sven Zukunft Jan-Niklas Eckardt Silvia Schäfer Sebastian Stasik Maher Hanoun Thomas Schroeder Lars Fransecky Björn Steffen Stefan W. Krause Sebastian Scholl Andreas Hochhaus Tim Sauer Sabrina Kraus Kerstin Schäfer-Eckart Martin Kaufmann Edgar Jost Tim Brümmendorf Christoph Schliemann Jan-Henrik Mikesch Utz Krug Mathias Hänel Anke Morgner Markus Schaich Andreas Neubauer Roland Repp Dirk Niemann Ruth Seggewiss-Bernhardt Achim Meinhardt Johannes Kullmer Ulrich Kaiser Wolfgang Blau Alexander Kiani Götz Ulrich Grigoleit Aristoteles Giagounidis Alexander A. Wurm Heidi Altmann Jan Moritz Middeke Johannes Schetelig Carsten Müller-Tidow Friedrich Stölzel Claudia D. Baldus Uwe Platzbecker Hubert Serve Martin Bornhäuser Christian Thiede Christoph Röllig |
| author_sort | Leo Ruhnke |
| collection | DOAJ |
| description | Abstract: In 2022, the European LeukemiaNet (ELN) risk stratification for patients with acute myeloid leukemia (AML) has been updated. We aimed to validate the prognostic value of the 2022 ELN classification (ELN22) by evaluating 1570 patients with newly diagnosed AML (median age, 56 years) treated with cytarabine-based intensive chemotherapy regimens. Compared with 2017 ELN classification (ELN17), which allocated 595 (38%), 413 (26%), and 562 patients (36%) to the favorable-, intermediate-, and adverse-risk categories, ELN22 classified 575 (37%), 410 (26%), and 585 patients (37%) as favorable, intermediate, and adverse risk, respectively. Risk group allocation was revised in 340 patients (22%). Most patients were reclassified into the ELN22 intermediate- or ELN22 adverse-risk group. The allocation of patients according to the ELN22 risk categories resulted in a significantly distinct event-free survival (EFS), relapse-free survival, and overall survival (OS). Compared with ELN17, reallocation according to the ELN22 recommendations resulted in a significantly improved prognostic discrimination for OS (3-year area under the curve, 0.71 vs 0.67). In patients with ELN22 favorable-risk AML, co-occurring myelodysplasia-related (MR) gene mutations did not significantly affect outcomes. Within the ELN22 adverse-risk group, we observed marked survival differences across mutational groups (5-year OS rate of 21% and 3% in patients with MR gene mutations and TP53 mutations, respectively). In patients harboring MR gene mutations, EZH2-, STAG2-, and ZRSR2-mutated patients showed an intermediate-like OS. In patients with secondary AML and those who underwent allogeneic hematopoietic cell transplantation, EFS and OS significantly differed between ELN22 risk groups, whereas the prognostic abilities of ELN17 and ELN22 classifications were similar. In conclusion, ELN22 improves prognostic discrimination in a large cohort of intensively treated patients with AML. Given the heterogeneous outcome in patients with MR gene alterations, ranging between those of intermediate and adverse risk patients, we suggest re-evaluation of risk allocation in these patients. |
| format | Article |
| id | doaj-art-daabb8a8540349dc9db2f5d80e23fb5b |
| institution | OA Journals |
| issn | 2473-9529 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Blood Advances |
| spelling | doaj-art-daabb8a8540349dc9db2f5d80e23fb5b2025-08-20T02:07:40ZengElsevierBlood Advances2473-95292025-03-01961392140410.1182/bloodadvances.2024013304Validation of the revised 2022 European LeukemiaNet risk stratification in adult patients with acute myeloid leukemiaLeo Ruhnke0Marius Bill1Sven Zukunft2Jan-Niklas Eckardt3Silvia Schäfer4Sebastian Stasik5Maher Hanoun6Thomas Schroeder7Lars Fransecky8Björn Steffen9Stefan W. Krause10Sebastian Scholl11Andreas Hochhaus12Tim Sauer13Sabrina Kraus14Kerstin Schäfer-Eckart15Martin Kaufmann16Edgar Jost17Tim Brümmendorf18Christoph Schliemann19Jan-Henrik Mikesch20Utz Krug21Mathias Hänel22Anke Morgner23Markus Schaich24Andreas Neubauer25Roland Repp26Dirk Niemann27Ruth Seggewiss-Bernhardt28Achim Meinhardt29Johannes Kullmer30Ulrich Kaiser31Wolfgang Blau32Alexander Kiani33Götz Ulrich Grigoleit34Aristoteles Giagounidis35Alexander A. Wurm36Heidi Altmann37Jan Moritz Middeke38Johannes Schetelig39Carsten Müller-Tidow40Friedrich Stölzel41Claudia D. Baldus42Uwe Platzbecker43Hubert Serve44Martin Bornhäuser45Christian Thiede46Christoph Röllig47Department of Internal Medicine I, University Hospital Dresden, Technical University Dresden, Dresden, Germany; Correspondence: Leo Ruhnke, Department of Internal Medicine I, University Hospital Dresden, Technical University Dresden, Fetscherstraße 74, 01309 Dresden, Germany;Department of Internal Medicine I, University Hospital Dresden, Technical University Dresden, Dresden, Germany; Mildred Scheel Early Career Center, Department of Internal Medicine I, University Hospital Dresden, Technical University Dresden, Dresden, Germany; National Center for Tumor Diseases Dresden (NCT/UCC), Medical Faculty and University Hospital Dresden, Technical University Dresden, Dresden, Germany; German Cancer Consortium (DKTK), Dresden, GermanyDepartment of Internal Medicine I, University Hospital Dresden, Technical University Dresden, Dresden, GermanyDepartment of Internal Medicine I, University Hospital Dresden, Technical University Dresden, Dresden, Germany; Mildred Scheel Early Career Center, Department of Internal Medicine I, University Hospital Dresden, Technical University Dresden, Dresden, Germany; Else Kröner Fresenius Center for Digital Health, Technical University Dresden, Dresden, GermanyMildred Scheel Early Career Center, Department of Internal Medicine I, University Hospital Dresden, Technical University Dresden, Dresden, Germany; National Center for Tumor Diseases Dresden (NCT/UCC), Medical Faculty and University Hospital Dresden, Technical University Dresden, Dresden, GermanyDepartment of Internal Medicine I, University Hospital Dresden, Technical University Dresden, Dresden, GermanyDepartment of Hematology, University Hospital Essen, University of Duisburg-Essen, Essen, GermanyDepartment of Hematology, University Hospital Essen, University of Duisburg-Essen, Essen, GermanyDepartment of Hematology and Oncology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, GermanyDepartment of Internal Medicine II, University Hospital Frankfurt, Frankfurt, GermanyDepartment of Internal Medicine V, Universitätsklinikum Erlangen, Erlangen, GermanyDepartment of Internal Medicine II, Hematology and Medical Oncology, University Hospital Jena, Jena, GermanyDepartment of Internal Medicine II, Hematology and Medical Oncology, University Hospital Jena, Jena, GermanyDepartment of Internal Medicine V, University of Heidelberg, Heidelberg, GermanyDepartment of Internal Medicine II, University Hospital Würzburg, Würzburg, GermanyDepartment of Internal Medicine V, Nuremberg Hospital North, Paracelsus Medical University, Nuremberg, GermanyDepartment of Hematology, Robert-Bosch-Krankenhaus, Stuttgart, GermanyDepartment of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, University Hospital Aachen and CIO ABCD Aachen, RWTH Aachen, Aachen, GermanyDepartment of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, University Hospital Aachen and CIO ABCD Aachen, RWTH Aachen, Aachen, GermanyDepartment of Medicine A, University Hospital Münster, Münster, GermanyDepartment of Medicine A, University Hospital Münster, Münster, GermanyDepartment of Medicine 3, Klinikum Leverkusen, Leverkusen, GermanyDepartment of Internal Medicine III, Klinikum Chemnitz, Chemnitz, GermanyDepartment of Internal Medicine III, Klinikum Chemnitz, Chemnitz, GermanyDepartment of Hematology, Oncology and Palliative Care, Rems-Murr-Hospital, Winnenden, GermanyDepartment of Internal Medicine, Hematology, Oncology and Immunology, University Hospital Marburg, Marburg, GermanyDepartment of Internal Medicine II, Städtisches Krankenhaus Kiel, Kiel, GermanyDepartment of Hematology, Oncology and Palliative Care, Gemeinschaftsklinikum Mittelrhein, Koblenz, GermanyDepartment of Internal Medicine V, Sozialstiftung Bamberg, Bamberg, GermanyDepartment of Hematology and Oncology, Agaplesion Diakonieklinikum Rotenburg, Rotenburg, GermanyDepartment of Internal Medicine II, DIAKO Bremen, Bremen, GermanyDepartment of Hematology, Oncology and Immunology, St. Bernward Hospital, Hildesheim, GermanyDepartment of Internal Medicine III, Hematology, Oncology and Palliative Care, Helios Dr. Horst Schmidt Klinikum Wiesbaden, Wiesbaden, GermanyDepartment of Hematology and Oncology, Klinikum Bayreuth GmbH, Bayreuth, Germany and Comprehensive Cancer Center-Europäische Metropolregion Nürnberg, Erlangen, GermanyDepartment of Hematology and Oncology, Helios Klinikum Duisburg, Duisburg, GermanyDepartment of Medical Oncology, Hematology and Palliative Care, Marien Hospital Düsseldorf, Düsseldorf, GermanyDepartment of Internal Medicine I, University Hospital Dresden, Technical University Dresden, Dresden, Germany; Mildred Scheel Early Career Center, Department of Internal Medicine I, University Hospital Dresden, Technical University Dresden, Dresden, Germany; National Center for Tumor Diseases Dresden (NCT/UCC), Medical Faculty and University Hospital Dresden, Technical University Dresden, Dresden, Germany; German Cancer Consortium (DKTK), Dresden, GermanyDepartment of Internal Medicine I, University Hospital Dresden, Technical University Dresden, Dresden, GermanyDepartment of Internal Medicine I, University Hospital Dresden, Technical University Dresden, Dresden, GermanyDepartment of Internal Medicine I, University Hospital Dresden, Technical University Dresden, Dresden, GermanyDepartment of Internal Medicine V, University of Heidelberg, Heidelberg, Germany; German Cancer Consortium (DKTK) partner site Dresden, Dresden, Germany and German Cancer Research Center (DKFZ), Heidelberg, GermanyDepartment of Hematology and Oncology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, GermanyDepartment of Hematology and Oncology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, GermanyDepartment of Internal Medicine I, Hematology and Cellular Therapy, University Hospital Leipzig, Leipzig, GermanyDepartment of Internal Medicine II, University Hospital Frankfurt, Frankfurt, GermanyDepartment of Internal Medicine I, University Hospital Dresden, Technical University Dresden, Dresden, Germany; Mildred Scheel Early Career Center, Department of Internal Medicine I, University Hospital Dresden, Technical University Dresden, Dresden, Germany; National Center for Tumor Diseases Dresden (NCT/UCC), Medical Faculty and University Hospital Dresden, Technical University Dresden, Dresden, Germany; German Cancer Consortium (DKTK), Dresden, GermanyDepartment of Internal Medicine I, University Hospital Dresden, Technical University Dresden, Dresden, Germany; Agendix GmbH, Dresden, GermanyDepartment of Internal Medicine I, University Hospital Dresden, Technical University Dresden, Dresden, GermanyAbstract: In 2022, the European LeukemiaNet (ELN) risk stratification for patients with acute myeloid leukemia (AML) has been updated. We aimed to validate the prognostic value of the 2022 ELN classification (ELN22) by evaluating 1570 patients with newly diagnosed AML (median age, 56 years) treated with cytarabine-based intensive chemotherapy regimens. Compared with 2017 ELN classification (ELN17), which allocated 595 (38%), 413 (26%), and 562 patients (36%) to the favorable-, intermediate-, and adverse-risk categories, ELN22 classified 575 (37%), 410 (26%), and 585 patients (37%) as favorable, intermediate, and adverse risk, respectively. Risk group allocation was revised in 340 patients (22%). Most patients were reclassified into the ELN22 intermediate- or ELN22 adverse-risk group. The allocation of patients according to the ELN22 risk categories resulted in a significantly distinct event-free survival (EFS), relapse-free survival, and overall survival (OS). Compared with ELN17, reallocation according to the ELN22 recommendations resulted in a significantly improved prognostic discrimination for OS (3-year area under the curve, 0.71 vs 0.67). In patients with ELN22 favorable-risk AML, co-occurring myelodysplasia-related (MR) gene mutations did not significantly affect outcomes. Within the ELN22 adverse-risk group, we observed marked survival differences across mutational groups (5-year OS rate of 21% and 3% in patients with MR gene mutations and TP53 mutations, respectively). In patients harboring MR gene mutations, EZH2-, STAG2-, and ZRSR2-mutated patients showed an intermediate-like OS. In patients with secondary AML and those who underwent allogeneic hematopoietic cell transplantation, EFS and OS significantly differed between ELN22 risk groups, whereas the prognostic abilities of ELN17 and ELN22 classifications were similar. In conclusion, ELN22 improves prognostic discrimination in a large cohort of intensively treated patients with AML. Given the heterogeneous outcome in patients with MR gene alterations, ranging between those of intermediate and adverse risk patients, we suggest re-evaluation of risk allocation in these patients.http://www.sciencedirect.com/science/article/pii/S2473952924006438 |
| spellingShingle | Leo Ruhnke Marius Bill Sven Zukunft Jan-Niklas Eckardt Silvia Schäfer Sebastian Stasik Maher Hanoun Thomas Schroeder Lars Fransecky Björn Steffen Stefan W. Krause Sebastian Scholl Andreas Hochhaus Tim Sauer Sabrina Kraus Kerstin Schäfer-Eckart Martin Kaufmann Edgar Jost Tim Brümmendorf Christoph Schliemann Jan-Henrik Mikesch Utz Krug Mathias Hänel Anke Morgner Markus Schaich Andreas Neubauer Roland Repp Dirk Niemann Ruth Seggewiss-Bernhardt Achim Meinhardt Johannes Kullmer Ulrich Kaiser Wolfgang Blau Alexander Kiani Götz Ulrich Grigoleit Aristoteles Giagounidis Alexander A. Wurm Heidi Altmann Jan Moritz Middeke Johannes Schetelig Carsten Müller-Tidow Friedrich Stölzel Claudia D. Baldus Uwe Platzbecker Hubert Serve Martin Bornhäuser Christian Thiede Christoph Röllig Validation of the revised 2022 European LeukemiaNet risk stratification in adult patients with acute myeloid leukemia Blood Advances |
| title | Validation of the revised 2022 European LeukemiaNet risk stratification in adult patients with acute myeloid leukemia |
| title_full | Validation of the revised 2022 European LeukemiaNet risk stratification in adult patients with acute myeloid leukemia |
| title_fullStr | Validation of the revised 2022 European LeukemiaNet risk stratification in adult patients with acute myeloid leukemia |
| title_full_unstemmed | Validation of the revised 2022 European LeukemiaNet risk stratification in adult patients with acute myeloid leukemia |
| title_short | Validation of the revised 2022 European LeukemiaNet risk stratification in adult patients with acute myeloid leukemia |
| title_sort | validation of the revised 2022 european leukemianet risk stratification in adult patients with acute myeloid leukemia |
| url | http://www.sciencedirect.com/science/article/pii/S2473952924006438 |
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