부산대학교 도서관

To validate the recent ELN classification in a large series of AML patients and to investigate if the inclusion of MK improved the prognostic stratification.804 consecutive patients treated under the CETLAM AML-99 (n=353) and CETLAM-03 (n=451) trials were analyzed. The two protocols included idarubicin, intermediate-dose cytarabine and etoposide as induction and mitoxantrone and intermediate-dose cytarabine as consolidation. G-CSF priming was given in the CETLAM-03 trial. Following, risk-adapted treatment with chemotherapy or hematopoietic transplantation was administered. Parameters analyzed were relapse rate (REL), leukemia-free survival (LFS) and overall survival (OS).Median age of the series was 46 years (range 16–60). Median follow-up of patients alive was 15 months. The ELN classification resulted in different prognostic risk groups. At 5 years, ELN favorable risk category had an OS of 60±4%, intermediate-I of 32±%, intermediate-II of 46±% and adverse of 17±3% (p<0.001). REL was comparable in the intermediate-I and adverse groups, 59±6% and 63±6% respectively, which translated into similar LFS. In contrast to the partial predictive value of the ELN proposal in our series, particularly in the intermediate categories, modified criteria identified 5 significantly different genetic risk groups: a) patients with RUNX1-RUNX1-T1 or CBFB-MYH11, b) patients with CEBPA or NPM1 mutations without FLT3-ITD, c) patients with intermediate cytogenetics of the MRC classification without mutations in CEBPA, NPM1 nor FLT3-ITD, and with FLT3-ITD, d) adverse MRC cytogenetics without MK and, e) patients with MK. Overall survival at 5 years for the 5 groups was 66±5%, 59±5%, 32±4%, 15±5%, and 4±4%, respectively (p<0.001).In the present study, the ELN genetic classification did not discriminate the prognosis of patients in the intermediate-I and intermediate-II categories. In contrast, genetic grouping that considered CBF AML, favorable mutations in the intermediate cytogenetics category and that separated adverse karyotype with or without MK translated into significantly different OS. This classification, together with the study of mutations recently described and the expression of certain genes may contribute to a more precise prognostic stratification and risk-adapted therapy.No relevant conflicts of interest to declare.