Table 1.
High-risk features in newly diagnosed AML.
| Clinical factors |
|---|
| Age >60 years |
| Antecedent hematological disorders |
| Treatment-related |
| Leukemia with persistence of minimal residual disease after induction chemotherapya |
| Cytogenetic and molecular features |
| t(6;9)(p23;q34.1); DEK-NUP214b |
| t(v;11q23.3);KMT2A rearrangements, multiple fusion partners |
| t(9;22)(q34.1;q11.2); BCR-ABL1 |
| inv(3)(q21.3q26.2) or t(3;3)(q21.3;q26.2); GATA2.MECOM(EVI1) |
| −5 or del(5q); −7; −17/abn(17p) |
| Complex karyotype or monosomal karyotype |
| Mutations within ELN adverse risk stratification |
| FLT3-ITD high+ wild type NPM1 |
| RUNX1c |
| ASXL1c |
| TP53 |
| Proposed high risk mutations to be included in ELN |
| KIT mutations |
| RNA Spliceomes (NRAS and KRAS) |
| RNA splicing (e.g., SRSF2, SF3B1, U2AF1, and ZRSR2) |
| DNMT3A |
| BCOR |
| Complex molecular genetic abnormalities involving three or more genes |
a
Residual disease defined by multiparameter flow cytometry or positive PCR for disease-specific genes describes a group of patients with significant risk of early recurrence after consolidation therapy, including consolidation in the form of allogeneic transplantation.
b
More recent data suggests that t(6;9)(p23;q34.1) should likely be re-classified within the intermediate risk group if treated intensively with allogeneic HSCT.5,6
c
Should not be used as an adverse prognostic marker if they co-occur with favorable-risk AML subtypes.
AML, acute myeloid leukemia; ELN, European LeukemiaNet; HSCT, hematopoietic stem cell transplantation; PCR, polymerase chain reaction.