Long-Term Prognosis of Acute Myeloid Leukemia According to the New Genetic Risk Classification of the European LeukemiaNet Recommendations: Evaluation of the Proposed Reporting System

Author:

Röllig Christoph1,Bornhäuser Martin1,Thiede Christian1,Taube Franziska1,Kramer Michael1,Mohr Brigitte1,Aulitzky Walter1,Bodenstein Heinrich1,Tischler Hans-Joachim1,Stuhlmann Reingard1,Schuler Ulrich1,Stölzel Friedrich1,von Bonin Malte1,Wandt Hannes1,Schäfer-Eckart Kerstin1,Schaich Markus1,Ehninger Gerhard1

Affiliation:

1. Christoph Röllig, Martin Bornhäuser, Christian Thiede, Franziska Taube, Michael Kramer, Brigitte Mohr, Ulrich Schuler, Friedrich Stölzel, Malte von Bonin, Markus Schaich, and Gerhard Ehninger, Medizinische Klinik und Poliklinik I, Universitätsklinikum Dresden, Dresden; Walter Aulitzky, Robert-Bosch-Krankenhaus Abteilung für Hämatologie, Onkologie und Palliativmedizin, Stuttgart; Heinrich Bodenstein and Hans-Joachim Tischler, Klinikum Minden, Klinik für Hämatologie und Onkologie, Minden; Reingard...

Abstract

Purpose The current European LeukemiaNet (ELN) recommendations for acute myeloid leukemia (AML) propose a new risk reporting system, integrating molecular and cytogenetic factors and subdividing the large heterogenous group of intermediate-risk patients into intermediate-I (IR-I) and intermediate-II (IR-II). We assessed the prognostic value of the new risk classification in a large cohort of patients. Patients and Methods Complete data for classification were available for 1,557 of 1,862 patients treated in the AML96 trial. Patients were assigned to the proposed genetic groups from the ELN recommendations, and survival analyses were performed using the Kaplan-Meier method and log-rank test for significance testing. Results The median age of all patients was 67 years. With a median follow-up of 8.3 years, significant differences between all risk categories were observed in patients age ≤ 60 years regarding the time to relapse, relapse-free survival, and overall survival (OS). Patients in the IR-II group had a better prognosis than patients in the IR-I group. The median OS times in young patients with favorable risk (FR), IR-I, IR-II, and adverse risk (AR) were 5.3, 1.1, 1.6, and 0.5 years, respectively. Separate analyses in the age group older than 60 years revealed significant differences between FR, AR, and IR as a whole, but not between IR-I and IR-II. Conclusion In younger patients with AML, the ELN classification seems to be the best available framework for prognostic estimations to date. Caution is advised concerning its use for prospective treatment allocation before it has been prospectively validated. In elderly patients, alternative prognostic factors are desirable for further risk stratification of IR.

Publisher

American Society of Clinical Oncology (ASCO)

Subject

Cancer Research,Oncology

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