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@ARTICLE{Ruhnke:300197,
      author       = {L. Ruhnke and M. Bill$^*$ and S. Zukunft and J.-N. Eckardt
                      and S. Schäfer and S. Stasik and M. Hanoun and T. Schroeder
                      and L. Fransecky and B. Steffen and S. W. Krause and S.
                      Scholl and A. Hochhaus and T. Sauer and S. Kraus and K.
                      Schäfer-Eckart and M. Kaufmann and E. Jost and T.
                      Brümmendorf and C. Schliemann and J.-H. Mikesch and U. Krug
                      and M. Hänel and A. Morgner and M. Schaich and A. Neubauer
                      and R. Repp and D. Niemann and R. Seggewiss-Bernhardt and A.
                      Meinhardt and J. Kullmer and U. Kaiser and W. Blau and A.
                      Kiani and G. U. Grigoleit and A. Giagounidis and A. A.
                      Wurm$^*$ and H. Altmann and J. M. Middeke and J. Schetelig
                      and C. Müller-Tidow$^*$ and F. Stölzel and C. D. Baldus
                      and U. Platzbecker and H. Serve and M. Bornhäuser$^*$ and
                      C. Thiede and C. Röllig},
      title        = {{V}alidation of the revised 2022 {E}uropean {L}eukemia{N}et
                      risk stratification in adult patients with acute myeloid
                      leukemia.},
      journal      = {Blood advances},
      volume       = {9},
      number       = {6},
      issn         = {2473-9529},
      address      = {Washington, DC},
      publisher    = {American Society of Hematology},
      reportid     = {DKFZ-2025-00674},
      pages        = {1392 - 1404},
      year         = {2025},
      abstract     = {In 2022, the European LeukemiaNet (ELN) risk stratification
                      for patients with acute myeloid leukemia (AML) has been
                      updated. We aimed to validate the prognostic value of the
                      2022 ELN classification (ELN22) by evaluating 1570 patients
                      with newly diagnosed AML (median age, 56 years) treated with
                      cytarabine-based intensive chemotherapy regimens. Compared
                      with 2017 ELN classification (ELN17), which allocated 595
                      $(38\%),$ 413 $(26\%),$ and 562 patients $(36\%)$ to the
                      favorable-, intermediate-, and adverse-risk categories,
                      ELN22 classified 575 $(37\%),$ 410 $(26\%),$ and 585
                      patients $(37\%)$ as favorable, intermediate, and adverse
                      risk, respectively. Risk group allocation was revised in 340
                      patients $(22\%).$ Most patients were reclassified into the
                      ELN22 intermediate- or ELN22 adverse-risk group. The
                      allocation of patients according to the ELN22 risk
                      categories resulted in a significantly distinct event-free
                      survival (EFS), relapse-free survival, and overall survival
                      (OS). Compared with ELN17, reallocation according to the
                      ELN22 recommendations resulted in a significantly improved
                      prognostic discrimination for OS (3-year area under the
                      curve, 0.71 vs 0.67). In patients with ELN22 favorable-risk
                      AML, co-occurring myelodysplasia-related (MR) gene mutations
                      did not significantly affect outcomes. Within the ELN22
                      adverse-risk group, we observed marked survival differences
                      across mutational groups (5-year OS rate of $21\%$ and $3\%$
                      in patients with MR gene mutations and TP53 mutations,
                      respectively). In patients harboring MR gene mutations,
                      EZH2-, STAG2-, and ZRSR2-mutated patients showed an
                      intermediate-like OS. In patients with secondary AML and
                      those who underwent allogeneic hematopoietic cell
                      transplantation, EFS and OS significantly differed between
                      ELN22 risk groups, whereas the prognostic abilities of ELN17
                      and ELN22 classifications were similar. In conclusion, ELN22
                      improves prognostic discrimination in a large cohort of
                      intensively treated patients with AML. Given the
                      heterogeneous outcome in patients with MR gene alterations,
                      ranging between those of intermediate and adverse risk
                      patients, we suggest re-evaluation of risk allocation in
                      these patients.},
      keywords     = {Humans / Leukemia, Myeloid, Acute: diagnosis / Leukemia,
                      Myeloid, Acute: therapy / Leukemia, Myeloid, Acute:
                      mortality / Middle Aged / Male / Adult / Female / Aged /
                      Prognosis / Risk Assessment / Young Adult / Europe / Aged,
                      80 and over / Adolescent / Antineoplastic Combined
                      Chemotherapy Protocols: therapeutic use},
      cin          = {DD01},
      ddc          = {610},
      cid          = {I:(DE-He78)DD01-20160331},
      pnm          = {899 - ohne Topic (POF4-899)},
      pid          = {G:(DE-HGF)POF4-899},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:39504561},
      doi          = {10.1182/bloodadvances.2024013304},
      url          = {https://inrepo02.dkfz.de/record/300197},
}