Validating the European LeukemiaNet 2022 Guidelines in a Middle Eastern Acute Myeloid Leukemia Cohort: Correlation With Survival Outcomes and Comparison to ELN 2017.

The European LeukemiaNet (ELN) guidelines are widely used for risk stratification in acutemyeloid leukemia (AML), but validation in non Western patients remains limited. This retrospective study of 227 newly diagnosed AML patients from the Kuwait Cancer Control Center assessed the 2022 and 2017 ELN risk classification systems and their impact on event-free survival (EFS) and overall survival (OS), add ressing the need for diverse population data in AML prognostication. Compared to ELN2017, ELN2022 reclassified 14% of patients. Outcomes were effectively discriminated by both ELN2017 (EFS C index 0.607, log rank P < .001; OS C index 0.591, P < 001) and ELN2022 (EFS C index 0.607, P < .001; OS C index 0.590, P < .001). Among 171 patients receiving intensive chemotherapy (IC), ELN2022 was even more discriminative (EFS C index 0.650; OS C index 0.637). Multivariable analyses confirm ELN2022 as an independent predictor of outcomes for the full cohort (EFS 2df Wald P < .001; OS P = .004) and IC subset (EFS P < .001; OS P = .001). Consistent with Western findings, neither ELN system was validated in our subgroup of 28 nonintensively treated patients (for ELN2022, adverse risk had the longest median EFS and OS). ELN2022 was an independent predictor of survival in a Middle Eastern AML cohort, particularly for patients receiving IC, validating this prognostic tool in an understudied population.