Beat-AML 2024 ELN 对新诊断 AML 接受较低强度治疗的老年人进行了细化风险分层。
Beat-AML 2024 ELN-Refined Risk Stratification for Older Adults with Newly Diagnosed AML Given Lower-Intensity Therapy.
发表日期：2024 Aug 07
作者：
Fieke W Hoff, William Blum, Ying Huang, Rina Li Welkie, Ronan Swords, Elie Traer, Eytan M Stein, Tara L Lin, Kellie J Archer, Prapti A Patel, Robert H Collins, Maria R Baer, Vu H Duong, Martha L Arellano, Wendy Stock, Olatoyosi Odenike, Robert L Redner, Tibor J Kovacsovics, Michael W Deininger, Joshua F Zeidner, Rebecca L Olin, Catherine C Smith, James M Foran, Gary J Schiller, Emily Curran, Kristin L Koenig, Nyla A Heerema, Timothy L Chen, Molly Martycz, Mona Stefanos, Leonard Rosenberg, Brian J Druker, Ross L Levine, Amy Burd, Ashley O Yocum, Uma Borate, Alice S Mims, John C Byrd, Yazan F Madanat
来源：
Blood Advances
摘要：
虽然 2022 年欧洲白血病网 (ELN) 急性髓性白血病 (AML) 风险分类可靠地预测了接受强化化疗的年轻患者的结果，但尚不清楚它是否适用于接受较低强度治疗 (LIT) 的 60 岁以上成人。我们的目的是测试 ELN 风险对接受 LIT 的新诊断 (ND) AML ≥ 60 岁患者的预后影响，并进一步细化这些患者的风险分层。总共纳入 595 名患者：根据 ELN 的定义，11% 具有有利风险，11% 具有中等风险，78% 具有不利风险 AML。 ELN 风险可预测总生存期 (OS)（P<0.001），但并未将有利风险与中等风险进行分层（P=0.71）。在不良风险 AML 中，进一步评估了其他分子异常的影响。对训练集 (N=316) 进行多变量分析，确定 IDH2 突变为独立的有利预后因素，KRAS、MLL2 和 TP53 突变为不利预后因素 (P<0.05)。计算这些突变的每种组合的“突变评分”，将不良风险患者分为两个风险组：-1 至 0 分（“Beat-AML-中级”）与 1 分（“Beat-AML-adverse”） ）。在最终的细化风险分类中，除了 ELN 不良风险内的突变评分之外，ELN 有利风险和中等风险组还被合并为新定义的“Beat-AML 有利风险”。这种方法重新定义了老年 ND AML 的风险，并提出了细化的 Beat-AML 有利风险组 (22%)、Beat-AML 中间风险组 (41%) 和 Beat-AML 不利风险组 (37%)，并改善了对以下风险的区分： OS（2 年 OS：分别为 48% vs 33% vs 11%，P<0.001；C 指数：ELN 为 0.60 vs 0.55），为患者和提供者提供治疗决策的附加信息。版权所有 © 2024 美国协会血液学。
While the 2022 European LeukemiaNet (ELN) acute myeloid leukemia (AML) risk classification reliably predicts outcomes in younger patients treated with intensive chemotherapy, it is unclear whether it applies to adults ≥ 60 years treated with lower-intensity treatment (LIT). We aimed to test the prognostic impact of ELN risk in patients with newly diagnosed (ND) AML ≥ 60 years given LIT and to further refine risk stratification for these patients. A total of 595 patients were included: 11% had favorable-risk, 11% had intermediate-risk, and 78% had adverse-risk AML as defined by ELN. ELN risk was prognostic for overall survival (OS) (P<0.001) but did not stratify favorable-risk from intermediate-risk (P=0.71). Within adverse-risk AML, the impact of additional molecular abnormalities was further evaluated. Multivariable analysis was performed on a training set (N=316) and identified IDH2 mutation as an independent favorable prognostic factor, and KRAS, MLL2, and TP53 mutations as unfavorable (P<0.05). A "mutation-score" was calculated for each combination of these mutations, assigning adverse-risk patients into two risk groups: -1 to 0 points ("Beat-AML-intermediate") vs 1+ points ("Beat-AML-adverse"). In the final refined risk classification, the ELN favorable- and intermediate-risk groups were combined into a newly defined "Beat-AML-favorable-risk", in addition to mutation scoring within the ELN adverse-risk. This approach redefines risk for older ND AML and proposes refined Beat-AML-favorable- (22%), Beat-AML-intermediate- (41%), and Beat-AML-adverse-risk (37%) groups with improved discrimination for OS (2-year OS: 48% vs 33% vs 11%, respectively, P<0.001; C-index: 0.60 vs 0.55 for ELN), providing patients and providers additional information for treatment decision-making.Copyright © 2024 American Society of Hematology.