Beat-AML 2024 ELN–refined risk stratification for older adults with newly diagnosed AML given lower-intensity therapy Journal Article
| Authors: | Hoff, F. W.; Blum, W. G.; Huang, Y.; Welkie, R. L.; Swords, R. T.; Traer, E.; Stein, E. M.; Lin, T. L.; Archer, K. J.; Patel, P. A.; Collins, R. H.; Baer, M. R.; Duong, V. H.; Arellano, M. L.; Stock, W.; Odenike, O.; Redner, R. L.; Kovacsovics, T.; Deininger, M. W.; Zeidner, J. F.; Olin, R. L.; Smith, C. C.; Foran, J. M.; Schiller, G. J.; Curran, E. K.; Koenig, K. L.; Heerema, N. A.; Chen, T.; Martycz, M.; Stefanos, M.; Marcus, S. G.; Rosenberg, L.; Druker, B. J.; Levine, R. L.; Burd, A.; Yocum, A. O.; Borate, U. M.; Mims, A. S.; Byrd, J. C.; Madanat, Y. F. |
| Article Title: | Beat-AML 2024 ELN–refined risk stratification for older adults with newly diagnosed AML given lower-intensity therapy |
| Abstract: | Although 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 aged ≥60 years given LIT and to further refine risk stratification for these patients. A total of 595 patients were included: 11% had favorable-, 11% intermediate-, and 78% had adverse-risk AML. ELN risk was prognostic for overall survival (OS) (P < .001) but did not stratify favorable- from intermediate-risk (P = .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 < .05). A “mutation score” was calculated for each combination of these mutations, assigning adverse-risk patients to 2 risk groups: −1 to 0 points (“Beat-AML intermediate”) vs 1+ points (“Beat-AML adverse”). In the final refined risk classification, ELN favorable- and intermediate-risk were combined into a newly defined “Beat-AML favorable-risk” group, in addition to mutation scoring within the ELN adverse-risk group. This approach redefines risk for older patients with ND AML and proposes refined Beat-AML risk groups with improved discrimination for OS (2-year OS, 48% vs 33% vs 11%, respectively; P < .001), providing patients and providers additional information for treatment decision-making. © 2024 by The American Society of Hematology. Licensed. |
| Keywords: | adult; controlled study; aged; unclassified drug; gene mutation; major clinical study; overall survival; cancer diagnosis; cytogenetics; protein p53; cancer therapy; risk factor; risk assessment; high risk population; k ras protein; peptides and proteins; acute myeloid leukemia; isocitrate dehydrogenase 2; human; male; female; article; histone lysine n methyltransferase 2d; low intensity therapy |
| Journal Title: | Blood Advances |
| Volume: | 8 |
| Issue: | 20 |
| ISSN: | 2473-9529 |
| Publisher: | American Society of Hematology |
| Date Published: | 2024-10-22 |
| Start Page: | 5297 |
| End Page: | 5305 |
| Language: | English |
| DOI: | 10.1182/bloodadvances.2024013685 |
| PUBMED: | 39110987 |
| PROVIDER: | scopus |
| PMCID: | PMC11497398 |
| DOI/URL: | |
| Notes: | Article -- Source: Scopus |
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