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

Figures & data

Figure 1. Risk distribution between the European LeukemiaNet (ELN)−2017 and ELN-2022 risk stratification models. Fav, Favorable; Int, Intermediate; Adv, adverse.

Table 1. Clinical characteristics of acute myeloid leukemia (AML) patients.

Value^a	All patients (N = 123)	ELN-2022 Favorable (n = 15)	ELN-2022 Intermediate (n = 51)	ELN-2022 Adverse (n = 57)	P value
Characteristic
Age, median (range), years	75 (67–89)	76 (70–83)	75 (67–86)	77 (69–89)	0.669
Gender, male	62 (50.4)	9 (60.0)	24 (47.1)	29 (50.9)	0.665
Type of AML					0.144
De novo	112 (91.1)	15 (100)	48 (94.1)	49 (86.0)
Secondary	11 (8.9)	0 (0)	3 (5.9)	8 (14.0)
ELN-2017 risk stratification					<0.001
Favorable	22 (17.9)	15 (100)	5 (9.8)	2 (3.5)
Intermediate	62 (50.4)	0 (0)	43 (84.3)	19 (33.3)
Adverse	39 (31.7)	0 (0)	3 (5.9)	36 (63.2)
CR/CRi achieved	14 (11.4)	4 (26.7)	4 (7.8)	6 (10.5)	0.126
Overall response	42 (34.1)	7 (46.7)	19 (37.3)	16 (28.1)	0.333
Median cycle of decitabine (range)	6 (1–41)	5 (1–24)	4 (1–41)	3 (1–23)	0.225
Death	109 (88.6)	12 (80.0)	45 (88.2)	52 (91.2)	0.473

^a Values are n (%) unless otherwise defined. CR, complete remission; CRi, CR with incomplete hematologic recovery; ELN-2017, 2017 European LeukemiaNet; ELN-2022, 2022 European LeukemiaNet.

Table 2. ELN-2022 model risk distribution according to genetic abnormalities at initial diagnosis.

ELN-2022 risk category	Genetic abnormality	n (%)	CR and CRi	Overall response
Favorable risk (n = 15)	t(8:21)	1 (0.8)	1	1
	inv(16) or t(16;16)	1 (0.8)	0	0
	Mutated NPM1 without FLT3-ITD	13 (10.6)	2	6
	bZIP in-frame mutated CEBPα	0 (0)	0	0
Intermediate risk (n = 51)	Mutated NPM1 with FLT3-ITD	9 (7.3)	1	1
	Wild-type NPM1 with FLT3-ITD	7 (5.7)	0	5
	t(9;11)	1 (0.8)	0	0
	Cytogenetic and/or molecular abnormalities not classified as favorable or adverse	34 (27.6)	3	13
Adverse risk (n = 57)	t(6;9)	0 (0)		0
	t(v;11q23.3)	0 (0)		0
	t(9;22)	0 (0)		0
	t(8;16)	0 (0)		0
	inv(3) or t(3;3)	1 (0.8)		1
	t(3q26.2;v)	0 (0)	0	0
	−5, del(5q); −7;−17/abn(17p)	1 (0.8)	0	0
	Complex karyotype, monosomal karyotype	18 (14.6)	5	6
	Mutated ASXL1, BCOR, EZH2, RUNX1, SF3B1, SRSF2, STAG2, U2AF1, ZRSR2	36 (29.3)	3	8
	Mutated TP53	15 (12.2)	2	5

ELN-2022, 2022 European LeukemiaNet; CR, complete remission; CRi, CR with incomplete hematologic recovery.

Figure 2. Kaplan-Meier curves for elderly acute myeloid leukemia patients according to the European LeukemiaNet (ELN) risk stratification. (a) Overall survival (OS) and (b) event-free survival (EFS) according to the ELN-2022 risk stratification; (c) OS and (d) EFS according to the ELN-2017 risk stratification. Fav, Favorable; Int, Intermediate; Adv, adverse.

Table 3. Univariate and multivariate Cox-proportional hazard regression analyses for elderly acute myeloid leukemia (AML) patients.

Variables	Overall survival (OS)				Event-free survival (EFS)
	Univariate HR (95% CI)	P value	Multivariate HR (95% CI)	P value	Univariate HR (95% CI)	P value	Multivariate HR (95% CI)	P value
Age (decade)	1.78 (1.16–2.74)	0.009	1.82(1.19–2.78)	0.006	1.66 (1.09–2.55)	0.020	1.70 (1.20–2.58)	0.013
Gender, male	1.03 (0.70–1.50)	0.882			1.10 (0.75–1.60)	0.629
Bone marrow blast percentage at diagnosis	1.01 (1.00–1.01)	0.171			1.00 (1.00–1.01)	0.294
ELN-2022	1.42 (1.06–1.89)	0.033	1.40 (1.05–1.86)	0.022	1.42 (1.06–1.89)	0.019	1.44 (1.08–1.92)	0.013

Univariate analysis and multivariate Cox-proportional hazard regression analysis were conducted using the log-rank method. Multivariate analysis was performed using covariates with a P value of less than 0.1 in the univariate analysis.

HR, hazard ratio; CI, confidence interval; ELN-2022, 2022 European LeukemiaNet.

Figure 3. Kaplan-Meier curves for elderly acute myeloid leukemia patients according to the European LeukemiaNet (ELN) risk stratification. (a) Overall survival (OS) and (b) event-free survival (EFS) in the ELN-2017 favorable risk group; (c) OS and (d) EFS in the ELN-2017 intermediate risk group; (e) OS and (f) EFS in the ELN-2017 adverse risk group. Fav, Favorable; Int, Intermediate; Adv, adverse.