Proposed Refinement of 2022 European LeukemiaNet Adverse-Risk Group of AML Patients Using a Real-World Cohort.

The 2022 European LeukemiaNet (ELN 2022) is a widely used genotypic risk classification tool for the treatment and prognostication of acute myeloid leukemia (AML) patients. Our study evaluates its effectiveness in categorizing adverse-risk AML patients on standard therapy based on their overall survival (OS). : We conducted a retrospective study involving 256 AML patients. : Those in the ELN 2022 adverse-risk group had the shortest OS ( < 0.0001) and were predominantly characterized by myelodysplasia-related () mutations, complex karyotype (CK), monosomal karyotype (MK), and mutation (). Subclassification and analysis of this adverse-risk group based on the status revealed a significantly shorter OS compared to the adverse wild-type () counterparts ( = 0.0036). We propose refining the ELN 2022 adverse-risk group into two categories, adverse and adverse groups, to represent adverse- and ultra-adverse-risk groups, respectively. We used an external validation dataset to confirm our findings. : This refinement allows for a more accurate classification of these adverse-risk patients based on their clinical outcomes.