Table 2.
ELN 2017 versus ELN 2022.
| ELN 2017 | ELN 2022 | Comments |
|---|---|---|
| Favorable Risk | ||
| t(8;21)(q22;q22.1)/RUNX1::RUNX1T1 | t(8;21)(q22;q22.1)/RUNX1::RUNX1T1 | |
| inv(16)(p13.1q22) or t(16;16)(p13.1;q22)/CBFB::MYH11 | inv(16)(p13.1q22) or t(16;16)(p13.1;q22)/CBFB::MYH11 | |
| Mutated NPM1 without FLT3-ITD or with FLT3-ITD low | Mutated NPM1 without FLT3-ITD (and without adverse-risk cytogenetics) | FLT3-ITD allelic ratio is no longer considered due to the impact of midostaurin-based regimens and the absence of a standardized assay to assess it |
| Biallelic mutated CEBPA | bZIP in-frame mutated CEBPA | Mono- or biallelic mutational state lost its prognostic weight in the latter classification, with inframe bZIP mutations gaining a predominant role |
| Intermediate Risk | ||
| Mutated NPM1 with FLT3-ITD high | Mutated NPM1 with FLT3-ITD (and without adverse-risk cytogenetics) | |
| Wild-type NPM1 without FLT3-ITD or with FLT3-ITD low (without adverse-risk genetic lesions) | Wild-type NPM1 with FLT3-ITD (without adverse-risk genetic lesions or favorable cytogenetics) | FLT3-ITD showed an independent prognostic impact, globally placing patients at intermediate risk |
| t(9;11)(p21.3;q23.3)/MLLT3::KMT2A | t(9;11)(p21.3;q23.3)/MLLT3::KMT2A | |
| Cytogenetic abnormalities not classified as favorable or adverse | Cytogenetic abnormalities not classified as favorable or adverse | |
| Adverse Risk | ||
| t(6;9)(p23;q34.1); DEK::NUP214 | t(6;9)(p23;q34.1); DEK::NUP214 | |
| t(v;11q23.3); KMT2A rearranged | t(v;11q23.3); KMT2A-rearranged | |
| t(9;22)(q34.1;q11.2); BCR::ABL1 | t(9;22)(q34.1;q11.2); BCR::ABL1 | |
| t(8;16)(p11.2;p13.3)/KAT6A::CREBBP | New cytogenetic abnormality included in the ELN 2022 classification | |
| inv(3)(q21.3q26.2) or t(3;3)(q21.3;q26.2); GATA2, MECOM(EVI1) | inv(3)(q21.3q26.2) or t(3;3)(q21.3;q26.2)/GATA2, MECOM(EVI1) | |
| t(3q26.2;v)/MECOM(EVI1)-rearranged | New cytogenetic abnormality included in the ELN 2022 classification | |
| −5 or del(5q); −7; −17/abn(17p) | −5 or del(5q); −7; −17/abn(17p) | |
| Complex karyotype, monosomal karyotype | Complex karyotype, monosomal karyotype | Multiple trisomies or polysomies no longer define CK |
| Mutated RUNX1, ASXL1 | Mutated ASXL1, BCOR, EZH2, RUNX1, SF3B1, SRSF2, STAG2, U2AF1, and/or ZRSR2 | Additional gene mutations are added, irrespective of prior MDS history |
| Mutated TP53 | Mutated TP53 | At least a 10% VAF is required to classify patients as TP53-mutated |
| Wild-type NPM1 and FLT3-ITD high | FLT3-ITD define an intermediate risk, irrespective of its allelic ratio or concurrent NPM1 mutations | |
Abbreviations: ELN, European Leukemia Net; CK, complex karyotype.