Prognostic Impact of European LeukemiaNet Genetic Risk Stratification System in Adult Patients With Acute Myeloid Leukemia

ABSTRACT Background The European LeukemiaNet (ELN) 2017 Genetic Risk Stratification System is widely used to categorize adult acute myeloid leukemia (AML) patients into prognostic groups. This study aimed to evaluate the prognostic value of ELN2017 in predicting survival outcomes and to assess the impact of clinical and molecular factors such as age, FLT3 and NPM1 mutations, and allogeneic hematopoietic stem cell transplantation (allo‐HSCT). Methods A cohort of 186 adult AML patients was stratified into ELN2017 risk categories: favorable (19.6%), intermediate (54.6%), and adverse (25.76%). We analyzed overall survival (OS) and relapse‐free survival (RFS), with subgroup analyses based on age, FLT3 and NPM1 mutation status, and allogeneic allo‐HSCT. Results Three‐year OS was 68.09% (favorable), 45.36% (intermediate), and 22.87% (adverse). Five‐year OS declined to 34.47%, 34.99%, and 13.72%, respectively. Corresponding 3‐year RFS rates were 49.96%, 38%, and 12.98%, whereas 5‐year RFS rates were 39.97%, 30.40%, and 6.49%. Patients aged ≥60 years showed poorer survival across all risk groups. Among FLT3‐mutated cases, 5‐year OS was 50% in the favorable group and 41.10% in the intermediate group. Allo‐HSCT significantly improved 3‐year OS in intermediate‐risk patients from 33.80% to 63.00% and in adverse‐risk patients from 10.10% to 46.15%. Conclusions ELN2017 provides strong prognostic discrimination in adult AML despite the introduction of newer ELN guidelines. Patient age, FLT3/NPM1 mutations, and transplantation status further refine risk assessment and should guide individualized treatment strategies.