TY - JOUR
T1 - Validation of the 2017 European LeukemiaNet classification for acute myeloid leukemia with NPM1 and FLT3-internal tandem duplication genotypes
AU - Boddu, Prajwal C.
AU - Kadia, Tapan M.
AU - Garcia-Manero, Guillermo
AU - Cortes, Jorge
AU - Alfayez, Mansour
AU - Borthakur, Gautam
AU - Konopleva, Marina
AU - Jabbour, Elias J.
AU - Daver, Naval G.
AU - DiNardo, Courtney D.
AU - Naqvi, Kiran
AU - Yilmaz, Musa
AU - Short, Nicholas J.
AU - Pierce, Sherry
AU - Kantarjian, Hagop M.
AU - Ravandi, Farhad
N1 - Publisher Copyright:
© 2018 American Cancer Society
PY - 2019/4/1
Y1 - 2019/4/1
N2 - Background: The revised 2017 European LeukemiaNet (ELN) classification (ELN-2017) of acute myeloid leukemia (AML) divides patients into 3 prognostic risk categories, with additional factors such as the fms-like tyrosine kinase 3 (FLT3)–internal tandem duplication (ITD) allele ratio (AR) considered for risk stratification. To the best of the authors' knowledge, the prognostic usefulness of ELN-2017 in comparison with ELN-2010 in younger patients with AML has not been validated to date. Methods: The authors performed a retrospective study on patients aged <60 years who received idarubicin plus cytarabine (IA)–based induction chemotherapy for newly diagnosed AML. Results: According to ELN-2017 criteria, the number of patients in the favorable (Fav), intermediate (Int), and adverse (Adv) risk categories was 192 patients (27%), 331 patients (46%), and 192 patients (27%), respectively. Overall survival probabilities at 5 years in the Fav, Int, and Adv groups were 57%, 37%, and 18%, respectively. In comparison, the 5-year overall survival probabilities in the Fav (169 patients), intermediate (IR)-1 (80 patients), IR-2 (306 patients), and Adv (160 patients) ELN-2010 categories were 59%, 32%, 40%, and 14%, respectively. Although ELN-2010 historically distinguishes prognosis into IR-1 and IR-2 categories in younger patients, this difference was nullified in the current study cohort. When comparing patients with a low FLT3-ITD AR with those with a high FLT3-ITD AR, no significant differences in survival were noted among patients with nucleophosmin 1 (NPM1)-mutated AML (P =.28) or wild-type NPM1 (P =.35), and in those treated with IA alone (P =.79) or those treated with IA and a FLT3 inhibitor (P =.10). Conclusions: The ELN-2017 more accurately distinguishes prognosis in patients with newly diagnosed AML. The lack of prognostic significance for the FLT3-ITD AR needs further evaluation in different treatment settings.
AB - Background: The revised 2017 European LeukemiaNet (ELN) classification (ELN-2017) of acute myeloid leukemia (AML) divides patients into 3 prognostic risk categories, with additional factors such as the fms-like tyrosine kinase 3 (FLT3)–internal tandem duplication (ITD) allele ratio (AR) considered for risk stratification. To the best of the authors' knowledge, the prognostic usefulness of ELN-2017 in comparison with ELN-2010 in younger patients with AML has not been validated to date. Methods: The authors performed a retrospective study on patients aged <60 years who received idarubicin plus cytarabine (IA)–based induction chemotherapy for newly diagnosed AML. Results: According to ELN-2017 criteria, the number of patients in the favorable (Fav), intermediate (Int), and adverse (Adv) risk categories was 192 patients (27%), 331 patients (46%), and 192 patients (27%), respectively. Overall survival probabilities at 5 years in the Fav, Int, and Adv groups were 57%, 37%, and 18%, respectively. In comparison, the 5-year overall survival probabilities in the Fav (169 patients), intermediate (IR)-1 (80 patients), IR-2 (306 patients), and Adv (160 patients) ELN-2010 categories were 59%, 32%, 40%, and 14%, respectively. Although ELN-2010 historically distinguishes prognosis into IR-1 and IR-2 categories in younger patients, this difference was nullified in the current study cohort. When comparing patients with a low FLT3-ITD AR with those with a high FLT3-ITD AR, no significant differences in survival were noted among patients with nucleophosmin 1 (NPM1)-mutated AML (P =.28) or wild-type NPM1 (P =.35), and in those treated with IA alone (P =.79) or those treated with IA and a FLT3 inhibitor (P =.10). Conclusions: The ELN-2017 more accurately distinguishes prognosis in patients with newly diagnosed AML. The lack of prognostic significance for the FLT3-ITD AR needs further evaluation in different treatment settings.
KW - European LeukemiaNet
KW - acute myeloid leukemia
KW - allele ratio
KW - prognosis
KW - validation
KW - younger
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U2 - 10.1002/cncr.31885
DO - 10.1002/cncr.31885
M3 - Article
C2 - 30521114
AN - SCOPUS:85058021221
SN - 0008-543X
VL - 125
SP - 1091
EP - 1100
JO - Cancer
JF - Cancer
IS - 7
ER -