Applicability of 2022 classifications of acute myeloid leukemia in the real-world setting

Attardi, Enrico; Savi, Arianna; Borsellino, Beatrice; Piciocchi, Alfonso; Cipriani, Marta; Ottone, Tiziana; Fabiani, Emiliano; Divona, Mariadomenica; Travaglini, Serena; Pascale, Maria Rosaria; Awada, Hussein; Durmaz, Arda; Visconte, Valeria; Porta, Matteo Giovanni Della; Venditti, Adriano; Maciejewski, Jaroslaw P.; Gurnari, Carmelo; Voso, Maria Teresa

doi:10.1182/bloodadvances.2023010173

Cited by 6 publications

(1 citation statement)

References 32 publications

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“… 5 , 6 , 7 Nevertheless, the category of AML-MR is now the largest group of AML in the new classification systems, accounting for ∼35% by WHO-HAEM5 or 30% by ICC of all AML cases. 8 , 9 , 10 …”

Section: Introductionmentioning

confidence: 99%

A real-world analysis of clinical outcomes in AML with myelodysplasia-related changes: a comparison of ICC and WHO-HAEM5 criteria

Zhou,

Zhao,

Zarif

et al. 2024

Blood Advances

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The proposed 5th edition of the WHO classification of hematolymphoid tumors (WHO-HAEM5) and International Consensus Classification (ICC) employ different definitions of acute myeloid leukemia with myelodysplasia-related genetics (AML-MR). We conducted a retrospective study which included a cohort of 432 patients treated at our institution, with 354 WHO-AML-MR patients if classified according to WHO-HAEM5 or 276 ICC-AML-MR by gene mutation or cytogenetics (ICC-AML-MR-M/CG) patients if classified according to ICC. The clinicopathological features were similar, irrespective of the classification used, except for higher rates of complex karyotype, monosomy 17, TP53 mutations, and fewer RUNX1 mutations in the WHO-AML-MR group. TP53 mutations were associated with distinct clinicopathological features and dismal outcomes (hazard ratio [HR], 2.98; p < .001). ICC-AML-MR-M/CG group had superior outcome compared to the WHO-AML-MR group (HR 0.80, p = .032), mainly due to isolating out TP53 mutated AML to form a standalone entity. In the intensively treated group, WHO-AML-MR had significantly worse outcomes than AML by differentiation (HR: 1.97, p = .024). By ICC criteria, AML-MR defined by gene mutations or by cytogenetics had more inferior outcomes than AML not otherwise specified (HR: 2.11, p = .048 and HR: 2.55, p = .028; respectively). Furthermore, changing the order of defining AML-MR (i.e. by gene mutations or cytogenetics) did not significantly impact clinical outcomes. AML-MR defined by gene mutations or cytogenetic abnormalities showed similar outcomes regardless of the order of assignment (HR: 0.92, p = .73). We propose to harmonize the two classifications by excluding TP53 mutations from WHO-HAEM5 defined AML-MR group and combining AML-MR defined by gene mutations and cytogenetics to form a unified group.

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Section: Introductionmentioning

confidence: 99%

A real-world analysis of clinical outcomes in AML with myelodysplasia-related changes: a comparison of ICC and WHO-HAEM5 criteria

Zhou,

Zhao,

Zarif

et al. 2024

Blood Advances

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A practical algorithm for acute myeloid leukaemia diagnosis following the updated 2022 classifications

Della Porta,

Martinelli,

Rambaldi

et al. 2024

Critical Reviews in Oncology/Hematology

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Imatinib with intensive chemotherapy in AML with t(9;22)(q34.1;q11.2)/BCR::ABL1. A DATAML registry study

Gondran,

Dumas,

Bérard

et al. 2024

Blood Cancer J.

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Acute myeloid leukemia (AML) with t(9;22) (q34.1; q11.2)/BCR::ABL1, a distinct entity within the group of AML with defining genetic abnormalities, belong to the adverse-risk group of the 2022 ELN classification. However, there is little data on outcome since the era of tyrosine kinase inhibitors. Among 5819 AML cases included in the DATAML registry, 20 patients with de novo BCR::ABL1+AML (0.3%) were identified. Eighteen patients treated with standard induction chemotherapy were analyzed in this study. Imatinib was added to chemotherapy in 16 patients. The female-to-male ratio was 1.25 and median age was 54 years. The t(9;22) translocation was the sole chromosomal abnormality in 12 patients. Main gene mutations detected by NGS were ASXL1, RUNX1 and NPM1. Compared with patients with myeloid blast phase of chronic myeloid leukemia (CML-BP), de novo BCR::ABL1+AML had higher WBC, fewer additional chromosomal abnormalities, lower CD36 or CD7 expression and no ABL1 mutations. Seventeen patients (94.4%) achieved complete remission (CR) or CR with incomplete hematologic recovery. Twelve patients were allografted in first remission. With a median follow-up of 6.3 years, the median OS was not reached and 2-year OS was 77% (95% CI: 50–91). Four out of five patients who were not transplanted did not relapse. Comparison of BCR::ABL1+AML, CML-BP, 2017 ELN intermediate (n = 643) and adverse-risk patients (n = 863) showed that patients with BCR::ABL1+AML had a significant better outcome than intermediate and adverse-risk patients. BCR::ABL1+AML patients treated with imatinib and intensive chemotherapy should not be included in the adverse-risk group of current AML classifications.

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Applicability of 2022 classifications of acute myeloid leukemia in the real-world setting

Cited by 6 publications

References 32 publications

A real-world analysis of clinical outcomes in AML with myelodysplasia-related changes: a comparison of ICC and WHO-HAEM5 criteria

A real-world analysis of clinical outcomes in AML with myelodysplasia-related changes: a comparison of ICC and WHO-HAEM5 criteria

A practical algorithm for acute myeloid leukaemia diagnosis following the updated 2022 classifications

Imatinib with intensive chemotherapy in AML with t(9;22)(q34.1;q11.2)/BCR::ABL1. A DATAML registry study

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