Risk Classification Systems in AML

Patients with acute myeloid leukemia (AML) receive care guided by sophisticated risk classification systems that help health care teams predict treatment responses and plan optimal therapy approaches. The European Leukemia Net 2022 classification system categorizes patients into favorable, intermediate, or adverse risk groups based on genetic features and chromosomal abnormalities. Patients with favorable-risk disease, including those with core binding factor leukemias or certain NPM1 mutations, typically have better treatment outcomes and may not require bone marrow transplantation to achieve cure.

For patients receiving intensive chemotherapy, the traditional classification system focuses on complex genetic and chromosomal markers to guide treatment decisions. However, a newer 2024 classification system specifically addresses patients who receive lower-intensity treatments, recognizing that older adults and those with significant medical conditions may benefit from gentler approaches. This system primarily uses genetic mutations rather than chromosomal changes to predict outcomes, with TP53 mutations indicating particularly challenging cases requiring specialized management approaches.

The distinction between “fit” and “unfit” patients has evolved beyond simple age-based criteria to encompass comprehensive assessments of functional status, organ function, and overall health. Patients benefit from individualized evaluations that consider performance status, heart and kidney function, and the ability to tolerate treatment adverse effects. This personalized approach ensures that each patient receives the most appropriate therapy intensity while maximizing both survival chances and quality of life throughout their treatment journey.