Recommendation for alloHSCT in AML CR1 based on integrated risk profiles
| AML risk group‡ . | AML risk assessment criteria at diagnosis . | MRD after cycle 2 . | Risk of relapse following consolidation approach . | Prognostic scores for NRM that indicate alloHSCT as preferred consolidation . | |||
|---|---|---|---|---|---|---|---|
| Chemotherapy or autoHSCT (%) . | AlloHSCT (%) . | EBMT score52 . | HCT-CI score53 . | NRM risk (%) . | |||
| Good | –t(8;21) or AML1-ETO, WBC <20 | Positive or negative | 35-40 | 15-20 | NA (≤1) | NA (<1) | 10-15 |
| –inv16/t(16;16) or CBFB-MYH11 | |||||||
| –CEBPA-biallelic mutant-positive | |||||||
| –FLT3-ITD-negative/NMP1-positive | |||||||
| Intermediate | –CN –X –Y, WBC <100, CRe | Negative | 50-55 | 20-25 | ≤2 | ≤2 | <20-25 |
| –t(8;21) or AML1-ETO plus WBC >20 | |||||||
| or mutant KIT | |||||||
| Poor | –CN –X –Y, WBC <100, CRe | Positive | 70-80 | 30-40 | ≤3-4 | ≤3-4 | <30 |
| –t(8;21) or AML1-ETO, WBC >20 | Positive | ||||||
| and/or mutant KIT | |||||||
| –CN –X –Y, WBC <100, no CRe | Negative | ||||||
| –CN –X –Y, WBC >100 | Negative | ||||||
| –CA, but non-CBF, MK-negative, no abn3q26 | |||||||
| Very poor | –CN –X –Y, WBC >100 | Positive | >90 | 40-50 | ≤5 | ≤5 | <40 |
| –CA, but non-CBF, MK-negative, no abn3q26, EVI1-negative | Positive | ||||||
| –MK-positive | Positive or negative | ||||||
| –abn3q26 | |||||||
| –Non-CBF, EVI1-positive | |||||||
| –Non-CBF with mutant p53, or –mutant RUNX1, or mutant ASXL1 –or biallelic FLT3-ITD with –FLT3-ITD:FLT3 WT ratio of >0.6 | |||||||
| AML risk group‡ . | AML risk assessment criteria at diagnosis . | MRD after cycle 2 . | Risk of relapse following consolidation approach . | Prognostic scores for NRM that indicate alloHSCT as preferred consolidation . | |||
|---|---|---|---|---|---|---|---|
| Chemotherapy or autoHSCT (%) . | AlloHSCT (%) . | EBMT score52 . | HCT-CI score53 . | NRM risk (%) . | |||
| Good | –t(8;21) or AML1-ETO, WBC <20 | Positive or negative | 35-40 | 15-20 | NA (≤1) | NA (<1) | 10-15 |
| –inv16/t(16;16) or CBFB-MYH11 | |||||||
| –CEBPA-biallelic mutant-positive | |||||||
| –FLT3-ITD-negative/NMP1-positive | |||||||
| Intermediate | –CN –X –Y, WBC <100, CRe | Negative | 50-55 | 20-25 | ≤2 | ≤2 | <20-25 |
| –t(8;21) or AML1-ETO plus WBC >20 | |||||||
| or mutant KIT | |||||||
| Poor | –CN –X –Y, WBC <100, CRe | Positive | 70-80 | 30-40 | ≤3-4 | ≤3-4 | <30 |
| –t(8;21) or AML1-ETO, WBC >20 | Positive | ||||||
| and/or mutant KIT | |||||||
| –CN –X –Y, WBC <100, no CRe | Negative | ||||||
| –CN –X –Y, WBC >100 | Negative | ||||||
| –CA, but non-CBF, MK-negative, no abn3q26 | |||||||
| Very poor | –CN –X –Y, WBC >100 | Positive | >90 | 40-50 | ≤5 | ≤5 | <40 |
| –CA, but non-CBF, MK-negative, no abn3q26, EVI1-negative | Positive | ||||||
| –MK-positive | Positive or negative | ||||||
| –abn3q26 | |||||||
| –Non-CBF, EVI1-positive | |||||||
| –Non-CBF with mutant p53, or –mutant RUNX1, or mutant ASXL1 –or biallelic FLT3-ITD with –FLT3-ITD:FLT3 WT ratio of >0.6 | |||||||
Adapted from the European Leukemia Net recommendation by adding new molecular markers and MRD.5 The proposed patient-specific use of alloHSCT in AML CR1 integrates the individual risks for relapse and NRM and aims for a disease-free survival benefit of at least 10% for the individual patient compared with consolidation by a non-alloHSCT approach. The categorization of AML is based on cytogenetic, molecular, and clinical parameters (including white blood cell count [WBC]); subcategories are now designated good, intermediate, poor, and very poor, as currently used by the HOVON-SAKK Cooperative Consortium.
CA, cytogentic abnormalities; CBF, core binding factor; CN, cytogenetically normal; CRe, early complete remission; HCT-CI, hematopoietic cell transplantation comorbidity index; ITD, internal tandem duplication; MK, monosomal karyotype; NA, not applicable; –X –Y, deleted X or Y chromosome.