The 2022 European LeukemiaNet (ELN) updated the previous risk classification published in 2017 but the prognostic significance for allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains unclear. We enrolled 600 acute myeloid leukemia (AML) patients who underwent allo-HSCT to validate ELN-2022 genetic risk system and compared it with ELN-2017. There were 214 (35.67%), 162 (27.0%), and 224 (37.33%) patients in ELN-2022 favorable-, intermediate-, and adverse-risk group respectively and 86 patients (14.33%) experienced a shift in risk stratification compared to ELN-2017. Median and maximum follow-up time were 2.89 (95% CI 2.67 to 3.03) years and 8.78 years. The median overall survival (OS) was 73.8% (95% CI 67.5% to 80.3%), 63.9% (95% CI 56.7% to 72.0%) and 57.6% (95% CI 50.4% to 65.9%) in ELN-2022 favorable-, intermediate-, and adverse-risk group (P < 0.001). OS shortened significantly as the ELN-2022 risk stratification increased but didn’t significantly in ELN-2017 intermediate-risk compared to favorable-risk. Both ELN-2022 and ELN-2017 adverse-risk were associated with increased cumulative incidence of relapse (CIR). Time-dependent receiver operating characteristic (ROC) analysis showed that both ELN-2017 and ELN-2022 risk systems had limited prognostic ability for OS. We modified ELN-2022 risk system with pre-transplant minimal residual disease (MRD) and the modified risk system performed a significantly superior efficacy to ELN-2022 system.

中文翻译：

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急性髓系白血病患者接受异基因造血干细胞移植的结局：2022年ELN遗传风险系统的验证、比较和完善

2022 年欧洲白血病网 (ELN) 更新了 2017 年发布的先前风险分类，但同种异体造血干细胞移植 (allo-HSCT) 的预后意义仍不清楚。我们招募了 600 名接受异基因 HSCT 的急性髓系白血病 (AML) 患者来验证 ELN-2022 遗传风险系统，并将其与 ELN-2017 进行比较。 ELN-2022有利、中等和不利风险组中分别有214名（35.67%）、162名（27.0%）和224名（37.33%）患者，其中86名患者（14.33%）经历了风险分层的转变与 ELN-2017 相比。中位随访时间和最长随访时间分别为 2.89 年（95% CI 2.67 至 3.03）年和 8.78 年。 ELN-2022 中的中位总生存率 (OS) 分别为 73.8%（95% CI 67.5% 至 80.3%）、63.9%（95% CI 56.7% 至 72.0%）和 57.6%（95% CI 50.4% 至 65.9%）有利、中等和不利风险组（P < 0.001）。随着 ELN-2022 风险分层的增加，OS 显着缩短，但与有利风险相比，ELN-2017 中等风险的 OS 没有显着缩短。 ELN-2022 和 ELN-2017 不良风险均与累积复发率 (CIR) 增加相关。时间相关的受试者工作特征 (ROC) 分析显示，ELN-2017 和 ELN-2022 风险系统的 OS 预后能力有限。我们用移植前微小残留病（MRD）修改了 ELN-2022 风险系统，修改后的风险系统的疗效明显优于 ELN-2022 系统。