title: Long-term prognosis of acute myeloid leukemia according to the new genetic risk classification of the European LeukemiaNet recommendations: evaluation of the proposed reporting system.
abstract: OBJECTIVE
  The current European LeukemiaNet (ELN) recommendations for acute myeloid leukemia (AML) propose a new risk reporting system, integrating molecular and cytogenetic factors and subdividing the large heterogenous group of intermediate-risk patients into intermediate-I (IR-I) and intermediate-II (IR-II). We assessed the prognostic value of the new risk classification in a large cohort of patients.
  
  
  METHODS
  Complete data for classification were available for 1,557 of 1,862 patients treated in the AML96 trial. Patients were assigned to the proposed genetic groups from the ELN recommendations, and survival analyses were performed using the Kaplan-Meier method and log-rank test for significance testing.
  
  
  RESULTS
  The median age of all patients was 67 years. With a median follow-up of 8.3 years, significant differences between all risk categories were observed in patients age ≤ 60 years regarding the time to relapse, relapse-free survival, and overall survival (OS). Patients in the IR-II group had a better prognosis than patients in the IR-I group. The median OS times in young patients with favorable risk (FR), IR-I, IR-II, and adverse risk (AR) were 5.3, 1.1, 1.6, and 0.5 years, respectively. Separate analyses in the age group older than 60 years revealed significant differences between FR, AR, and IR as a whole, but not between IR-I and IR-II.
  
  
  CONCLUSIONS
  In younger patients with AML, the ELN classification seems to be the best available framework for prognostic estimations to date. Caution is advised concerning its use for prospective treatment allocation before it has been prospectively validated. In elderly patients, alternative prognostic factors are desirable for further risk stratification of IR.
authors.affiliation: Medizinische Klinik und Poliklinik I, Universitätsklinikum Dresden, Dresden, Germany. christoph.roellig@uniklinikumdresden.de
authors.forename: Christoph
authors.initials: C
authors.lastname: Röllig
authors.forename: Martin
authors.initials: M
authors.lastname: Bornhäuser
authors.forename: Christian
authors.initials: C
authors.lastname: Thiede
authors.forename: Franziska
authors.initials: F
authors.lastname: Taube
authors.forename: Michael
authors.initials: M
authors.lastname: Kramer
authors.forename: Brigitte
authors.initials: B
authors.lastname: Mohr
authors.forename: Walter
authors.initials: W
authors.lastname: Aulitzky
authors.forename: Heinrich
authors.initials: H
authors.lastname: Bodenstein
authors.forename: Hans-Joachim
authors.initials: HJ
authors.lastname: Tischler
authors.forename: Reingard
authors.initials: R
authors.lastname: Stuhlmann
authors.forename: Ulrich
authors.initials: U
authors.lastname: Schuler
authors.forename: Friedrich
authors.initials: F
authors.lastname: Stölzel
authors.forename: Malte
authors.initials: M
authors.lastname: von Bonin
authors.forename: Hannes
authors.initials: H
authors.lastname: Wandt
authors.forename: Kerstin
authors.initials: K
authors.lastname: Schäfer-Eckart
authors.forename: Markus
authors.initials: M
authors.lastname: Schaich
authors.forename: Gerhard
authors.initials: G
authors.lastname: Ehninger
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000235:genetics*; D020732:Cytogenetic Analysis; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000175:diagnosis* / Q000235:genetics* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods*; D017410:Practice Guidelines as Topic; D011379:Prognosis; D018570:Risk Assessment; D016019:Survival Analysis
chemical_list: D014408:Biomarkers, Tumor