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
Department of Hematology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
Shanghai Yuanqi Biomedical Technology Co., Ltd., Shanghai, China.
Front Med (Lausanne). 2023 Jun 23;10:1165445. doi: 10.3389/fmed.2023.1165445. eCollection 2023.
Diagnosis classification and risk stratification are 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 classifications and the 2017 and 2022 versions of ELN guidance.
AML patients were classified according to the 4th and 5th WHO classifications, as well as the 2017 and 2022 versions of the European LeukemiaNet (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%) patients in the AML, not otherwise specified (NOS) group according to the 4th WHO classification, were re-classified into the AML-MR (myelodysplasia-related), KMT2A rearrangement, and NUP98 rearrangement subgroups based on the 5th WHO classification. Referring to the ELN guidance, 16 patients in the favorable group, six patients in the adverse group, and 13 patients in the intermediate group based on the 2017 ELN guidance were re-classified to the intermediate and adverse groups based on the 2022 ELN guidance. Regrettably, the Kaplan-Meier curves showed that the survival of intermediate and adverse groups could not be distinguished well according to either the 2017 or 2022 ELN guidance. To this end, we constructed a risk model for Chinese AML patients, in which the clinical information (age and gender), gene mutations (, and ), and fusions (CBFB::MYH11 and RUNX1::RUNX1T1) were included, and our model could help divide the patients into favorable, intermediate, and adverse groups.
These results affirmed the clinical value of both WHO and ELN, but a more suitable prognosis model should be established in Chinese cohorts, such as the models we proposed.
诊断分类和风险分层在急性髓系白血病（AML）的预后预测和治疗选择中至关重要。在此，我们使用一个包含536例AML患者的数据库来比较世界卫生组织（WHO）第4版和第5版分类以及欧洲白血病网络（ELN）2017年和2022年版指南。
AML患者根据WHO第4版和第5版分类以及2017年和2022年版欧洲白血病网络（ELN）指南进行分类。采用带有对数秩检验的Kaplan-Meier曲线进行生存分析。
最大的变化是，根据WHO第4版分类，急性髓系白血病，未另行分类（NOS）组中有25例（5.2%）、8例（1.6%）和1例（0.2%）患者根据WHO第5版分类重新分类为AML-MR（骨髓增生异常相关）、KMT2A重排和NUP98重排亚组。参照ELN指南，基于2017年ELN指南的有利组中的16例患者、不利组中的6例患者和中间组中的13例患者根据2022年ELN指南重新分类为中间组和不利组。遗憾的是，Kaplan-Meier曲线显示，根据2017年或2022年ELN指南，中间组和不利组的生存情况无法很好地区分。为此，我们构建了一个中国AML患者的风险模型，其中纳入了临床信息（年龄和性别）、基因突变（ 和 ）以及融合基因（CBFB::MYH11和RUNX1::RUNX1T1），我们的模型有助于将患者分为有利、中间和不利组。
这些结果肯定了WHO和ELN的临床价值，但应在中国队列中建立更合适的预后模型，如我们提出的模型。
