Prognostic analysis according to the 2017 ELN risk stratification by genetics in adult acute myeloid leukemia patients treated in the Japan Adult Leukemia Study Group (JALSG) AML201 study
Prognostic analysis according to the 2017 ELN risk stratification by genetics in adult acute myeloid leukemia patients treated in the Japan Adult Leukemia Study Group (JALSG) AML201 study
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DOI：
10.1016/j.leukres.2018.01.008
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发表时间：
2018-03-01
影响因子：
2.7
通讯作者：
Kiyoi, Hitoshi
中科院分区：
文献类型：
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作者：
Harada, Yasuhiko;Nagata, Yasunobu;Kiyoi, Hitoshi
许多与急性髓性白血病（AML）预后相关的遗传改变已被确定，并推荐了几种基于遗传状态的风险分层系统。欧洲白血病网络（ELN）于2010年首次提出AML的风险分层系统（ELN-2010），最近发布了修订后的系统（ELN-2017）。我们验证了在日本成人白血病研究组（JALSG）AML-201研究中接受治疗的日本成人AML患者中每个ELN-2017风险类别的长期预后和临床特征。我们证明，ELN-2017的3风险类别系统与ELN-2010的4风险类别相比，成功区分了我们队列的总生存率和完全缓解率。然而，仍存在将患者分层为有利或中等风险类别的遗传类别存在争议; FLT 3-ITD的低等位基因比率不一定与FLT 3-ITD患者的预后更好相关，细胞遗传学异常可能影响具有有利遗传病变（如NPM 1和CEBPA突变）的患者的预后。随着许多分子靶向药物如FLT 3抑制剂的开发，我们必须继续修改遗传风险分层系统，以适应治疗策略的进展。
Many genetic alterations that are associated with the prognosis of acute myeloid leukemia (AML) have been identified, and several risk stratification systems based on the genetic status have been recommended. The European LeukemiaNet (ELN) first proposed the risk stratification system for AML in 2010 (ELN-2010), and recently published the revised system (ELN-2017). We validated the long-term prognosis and clinical characteristics of each ELN-2017 risk category in Japanese adult AML patients who were treated in the Japan Adult Leukemia Study Group (JALSG) AML-201 study. We demonstrated that the 3-risk category system of the ELN2017 successfully discriminated the overall survival and complete remission rates in our cohort in comparison with the 4-risk category of the ELN-2010. However, there were still genetic categories in which stratification of patients into favorable or intermediate risk categories was controversial; the low allelic ratio of FLT3-ITD was not necessarily associated with a better prognosis in patients with FLT3-ITD, and cytogenetic abnormalities may affect the prognosis in patients with favorable genetic lesions such as NPM1 and CEBPA mutations. As many molecular targeting agents, such as FLT3 inhibitors, have been developed, we must continue to modify the genetic risk stratification system to match the progression of therapeutic strategies.