文章：

异基因造血干细胞移植优化的ELN 2022风险分层：在西班牙造血干细胞移植组（GETH-TC）接受移植的急性髓系白血病患者中验证Adverse-Plus风险组

Allo-HCT refined ELN 2022 risk classification: validation of the Adverse-Plus risk group in AML patients undergoing allogeneic hematopoietic cell transplantation within the Spanish Group for Hematopoietic Cell Transplantation (GETH-TC)

原文发布日期：2025-03-21

DOI: 10.1038/s41408-025-01223-x

类型: Article

开放获取: 是

英文摘要：

This multicenter retrospective study by GETH-TC validates the prognostic value of the Allo-HCT Refined ELN 2022 risk classification in allografted AML patients. The new classification refines the ELN 2022 risk classification, dividing adverse-risk patients into two subgroups: Adv-Plus (AdvP), including those with complex karyotype, MECOM (EVI1) rearrangement, or TP53 mutations/del(17p), and an additional adverse group (Adv*). The study included 651 AML patients treated with at least one line of anthracycline-based induction therapy and in complete remission. According to the Allo-HCT Refined ELN 2022 risk classification, 19.4% (n = 126) patients were classified into the Favorable (Fav) risk, 38.1% (n = 248) into the Intermediate (Int) risk, 27.2% (n = 177) in the Adv* and 15.4% (n = 100) in the AdvP. Outcomes were significantly poorer for patients allocated in the AdvP risk group (5-year OS rate: 32.3%, 5-year LFS rate: 24.3%, both p < 0.001 with the rest of subgroups) and a higher CIR (5-year CIR: 64.3%, p < 0.001). Patients in the Adv* risk group had similar outcomes than patients in the Int risk group (5-year OS rate: 70.2% vs. 66.7%, p = 0.69, 5-year LFS rate: 63.8% vs. 55.9%, p = 0.33). Multivariate analysis confirmed the dismal outcomes for AdvP patients for OS: Hazard Ratio (HR) = 3.05, and LFS: HR = 2.66, both p < 0.001. Our findings validate the Allo-HCT Refined ELN 2022 classification as a robust prognostic tool, particularly highlighting the poor outcomes for the AdvP subgroup.
 

摘要翻译： 

这项由GETH-TC开展的多中心回顾性研究验证了Allo-HCT改良版ELN 2022风险分层在接受异基因造血干细胞移植的AML患者中的预后价值。新分层方案在ELN 2022风险分类基础上进行改良，将高危患者分为两个亚组：极高危组（AdvP，包括复杂核型、MECOM（EVI1）重排或TP53突变/del(17p)患者）和其他高危组（Adv*）。该研究纳入651例接受至少一线蒽环类药物诱导治疗并获得完全缓解的AML患者。根据Allo-HCT改良版ELN 2022风险分层，19.4%（126例）患者属于低危组，38.1%（248例）为中危组，27.2%（177例）为Adv*组，15.4%（100例）为AdvP组。AdvP组患者预后显著更差（5年总生存率32.3%，5年无白血病生存率24.3%，均较其他亚组p<0.001），且累积复发率更高（5年CIR 64.3%，p<0.001）。Adv*组患者与中危组患者预后相似（5年总生存率70.2% vs. 66.7%，p=0.69；5年无白血病生存率63.8% vs. 55.9%，p=0.33）。多变量分析证实AdvP患者的总生存（风险比3.05）和无白血病生存（风险比2.66）均显著恶化（均p<0.001）。本研究验证了Allo-HCT改良版ELN 2022分层作为可靠预后工具的临床价值，尤其明确了AdvP亚组的不良预后特征。

原文链接：

Allo-HCT refined ELN 2022 risk classification: validation of the Adverse-Plus risk group in AML patients undergoing allogeneic hematopoietic cell transplantation within the Spanish Group for Hematopoietic Cell Transplantation (GETH-TC)