AUTHOR=Wang Xiaoning , Wang Jie , Wei Suhua , Zhao Juan , Xin Beibei , Li Guoqing , Zhao Jing , Wu Di , Luo Minna , Zhao Sijie , Chen Ying , Liu Haibo , Zhang Hailing , Wang Jingcheng , Wang Wenjuan , Wang Huaiyu , Xiong Hui , He Pengcheng 

TITLE=The latest edition of WHO and ELN guidance and a new risk model for Chinese acute myeloid leukemia patients

JOURNAL=Frontiers in Medicine

VOLUME=Volume 10 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2023.1165445

DOI=10.3389/fmed.2023.1165445

ISSN=2296-858X

ABSTRACT=Diagnosis classification and risk stratification are of crucial in the prognosis prediction and treatment selection of acute myeloid leukemia (AML). Here, we used a database of 536 AML patients to compare the 4th and 5th WHO, and the 2017 and 2022 version of ELN guidance.  AML patients were classified according to the 4th and 5th WHO, as well as the 2017 and 2022 version of ELN guidance. Kaplan-Meier curves with log-rank tests were used for survival analysis.  The biggest change was that 25 (5.2%), 8 (1.6%) and 1 (0.2%) patient in the AML, not otherwise specified (NOS) group according to the 4th WHO were re-classified into the AML-MR (myelodysplasia-related), KMT2A rearrangement and NUP98 rearrangement subgroups based on the 5th WHO. Referring to the ELN guidance, 16 patients in the favorable group, 6 patients in adverse group and 13 patients in the intermediate group based on the 2017 ELN guidance were re-classified to intermediate and adverse group based on the 2022 ELN guidance. Regrettably, the Kaplan-Meier curves showed that the survival of intermediate and adverse group could not be distinguished well according to either the 2017 and 2022 ELN guidance. To this end, we constructed a risk model for Chinese AML patients, in which the clinical information (age, gender), gene mutations (NPM1, RUNX1, SH2B3, TP53), and fusions (CBFB::MYH11 and RUNX1::RUNX1T1) were included, and our model could divide the patients into favorable, intermediate and adverse groups well.These results affirmed the clinical value of both WHO and ELN, but more suitable prognosis model should be established in Chinese cohorts, such as the models we proposed.