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ELN 2022, ELN 2024, and Beat AML 2024: Treatment-specific prognostic validation for AML
A real-world validation study, evaluating the treatment-specific prognostic performance of European LeukemiaNet (ELN) 2022, ELN 2024, and Beat Acute Myeloid Leukemia (Beat AML) 2024 classifications in patients with acute myeloid leukemia (AML) treated with intensive chemotherapy (IC; n = 195), less-intensive treatment (LIT; n = 231), and/or allogeneic hematopoietic stem cell transplantation (allo-HSCT; n = 133), was published in Blood Neoplasia by Kewan et al. The primary endpoint was median overall survival (mOS).
Key data: At a median follow-up of 49.8 months, mOS was 15.7 months (95% confidence interval [CI], 12.5–20.9), and all three classifications stratified mOS (all p < 0.001). Compared with ELN 2024 (0.601; 95% CI, 0.567–0.635), c-indices for mOS prediction were higher with ELN 2022 (0.640; 95% CI, 0.611–0.670; p = 0.024) and Beat AML 2024 (0.635; 95% CI, 0.604–0.666; p = 0.010). Treatment-specific analyses showed that, among patients treated with IC, ELN 2022 (p = 0.012) and Beat AML 2024 (p = 0.010) had higher prognostic performance vs ELN 2024. Among patients treated with LIT, ELN 2024 and Beat AML 2024 better identified a favorable-risk group, although c-indices were comparable. Allo-HSCT improved survival (p < 0.001), and only adverse-risk Beat AML 2024 independently predicted inferior survival among recipients (hazard ratio [HR], 3.7; 95% CI, 1.7–8.2; p < 0.001).
Key learning: Beat AML 2024 was most informative in patients treated with IC, ELN 2024 and Beat AML 2024 better identified favorable-risk patients receiving LIT, and only adverse-risk Beat AML 2024 independently predicted worse survival in allo-HSCT recipients, supporting treatment-specific use of molecular risk classifications in AML.
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