Prognostic analysis according to European LeukemiaNet 2022 risk stratification for elderly patients with acute myeloid leukemia treated with decitabine

ABSTRACT

Objectives

This study aimed to evaluate the prognostic significance of the revised European LeukemiaNet (ELN)−2022 risk stratification model for 123 elderly acute myeloid leukemia (AML) patients treated with decitabine chemotherapy.

Results

Based on the ELN-2022 risk stratification, 15 (12.2%), 51 (41.5%), and 57 (46.3%) patients were classified as having favorable, intermediate, and high-risk AML, respectively. In comparison with the ELN-2017 risk stratification, the ELN-2022 risk stratification re-assigned 26 (21.1%) and three (2.4%) patients to the adverse and favorable risk groups, respectively. Survival analysis revealed distinctive overall survival (OS) outcomes among the ELN-2022 risk groups (6-month OS rate: 73.3%, 52.9%, and 47.7% for favorable, intermediate, and adverse risk, respectively; P = 0.101), with a parallel trend observed in the event-free survival (EFS) (6-month EFS rate: 73.3%, 52.9%, and 45.6% for favorable, intermediate, and adverse risk, respectively; P = 0.049). Notably, both OS and EFS in the favorable risk group were significantly superior in comparison to that of the adverse risk group (OS: P = 0.040, EFS: P = 0.030). Although the ELN-2022 C-index (0.559) was greater than the ELN-2017 C-index (0.539), the result was not statistically significant (P = 0.059). Based on the event net reclassification index, we consistently observed significant improvements in the ELN-2022 risk stratification for overall survival (0.21 at 6 months).

Conclusion

In conclusion, the revised ELN-2022 risk stratification model may have improved the risk classification of elderly AML patients treated with hypomethylating agents compared to the ELN-2017 risk stratification model.

KEYWORDS:

• Acute myeloid leukemia
• European LeukemiaNet
• elderly patients
• decitabine

Disclosure statement

No potential conflict of interest was reported by the author(s).

Availability of data and materials

The data may be obtained from the corresponding authors on reasonable request.

Ethical approval and consent to participate

This study was approved by the institutional ethics committees of all participating institutions and was conducted in accordance with the Declaration of Helsinki. The committees waived the need for informed consent given the retrospective nature of the study.

Author contributions

MK, JHA and DDHK designed the study; MK and SYA prepared the manuscript; TK, SHJ, GYS, DHY, JJL, MYK, JHP, MGH, JSA, HJK and DDHK critically reviewed the manuscript. All authors have read and approved the final manuscript.

Additional information

Funding

This research was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF), funded by the Ministry of Science, ICT, and Future Planning (NRF-2015R1A2A1A10054579) and the National R&D Program for Cancer Control, Ministry of Health & Welfare, Republic of Korea (1720160). This study was also supported by a grant (HCRI23006) from Chonnam National University Hwasun Hospital Institute for Biomedical Science and a National Research Foundation of Korea (NRF) grant funded by the Korean Government (MSIT) (No. 2018R1A2A1A05078480, 2022R1F1A1063836). Furthermore, this research was supported by a Korea Institute for Advancement of Technology (KIAT) grant funded by the Korean Government (MOTIE) (P0017144, Foundation of cutting-edge supporting infrastructure for precision medicine industry). The biospecimens used in this study were provided by the Biobank of Chonnam National University Hwasun Hospital, a member of the Korea Biobank.