European LeukemiaNet risk stratification by genetics
| Risk category . | Genetic abnormality . |
|---|---|
| Favorable | t(8,21)(q22,q22.1), RUNX1-RUNX1T1 |
| Favorable | inv(16)(p13.1q22) or t(16,16)(p13.1,q22), CBFB-MYH11 |
| Favorable | Mutated NPM1 without FLT3-ITD or with FLT3-ITDlow* |
| Favorable | Biallelic mutated CEBPA |
| Intermediate | Mutated NPM1 and FLT3-ITDhigh* |
| Intermediate | Wild-type NPM1 without FLT3-ITD or with FLT3-ITDlow* (without adverse-risk genetic lesions) |
| Intermediate | t(9,11)(p21.3,q23.3), MLLT3-KMT2A† |
| Intermediate | Cytogenetic abnormalities not classified as favorable or adverse |
| Adverse | t(6,9)(p23,q34.1), DEK-NUP214 |
| Adverse | t(v,11q23.3), KMT2A rearranged |
| Adverse | t(9,22)(q34.1,q11.2), BCR-ABL1 |
| Adverse | inv(3)(q21.3q26.2) or t(3,3)(q21.3,q26.2), GATA2, MECOM(EVI1) |
| Adverse | −5 or del(5q), −7, −17/abn(17p) |
| Adverse | Complex karyotype,‡ monosomal karyotype§ |
| Adverse | Wild-type NPM1 and FLT3-ITDhigh(a) |
| Adverse | Mutated RUNX1‖ |
| Adverse | Mutated ASXL1‖ |
| Adverse | Mutated TP53¶ |
| Risk category . | Genetic abnormality . |
|---|---|
| Favorable | t(8,21)(q22,q22.1), RUNX1-RUNX1T1 |
| Favorable | inv(16)(p13.1q22) or t(16,16)(p13.1,q22), CBFB-MYH11 |
| Favorable | Mutated NPM1 without FLT3-ITD or with FLT3-ITDlow* |
| Favorable | Biallelic mutated CEBPA |
| Intermediate | Mutated NPM1 and FLT3-ITDhigh* |
| Intermediate | Wild-type NPM1 without FLT3-ITD or with FLT3-ITDlow* (without adverse-risk genetic lesions) |
| Intermediate | t(9,11)(p21.3,q23.3), MLLT3-KMT2A† |
| Intermediate | Cytogenetic abnormalities not classified as favorable or adverse |
| Adverse | t(6,9)(p23,q34.1), DEK-NUP214 |
| Adverse | t(v,11q23.3), KMT2A rearranged |
| Adverse | t(9,22)(q34.1,q11.2), BCR-ABL1 |
| Adverse | inv(3)(q21.3q26.2) or t(3,3)(q21.3,q26.2), GATA2, MECOM(EVI1) |
| Adverse | −5 or del(5q), −7, −17/abn(17p) |
| Adverse | Complex karyotype,‡ monosomal karyotype§ |
| Adverse | Wild-type NPM1 and FLT3-ITDhigh(a) |
| Adverse | Mutated RUNX1‖ |
| Adverse | Mutated ASXL1‖ |
| Adverse | Mutated TP53¶ |
ITD, internal tandem duplication.
Low indicates low allelic ratio (<0.5), high indicates high allelic ratio (>0.5), and semiquantitative assessment of FLT3-ITD allelic ratio (using DNA fragment analysis) is determined as the ratio of the area under the curve FLT3-ITD divided by the area under the curve FLT3-wild type.
The presence of t(9,11)(p21.3,q23.3) takes precedence over rare, concurrent adverse-risk gene mutations.
Three or more unrelated chromosome abnormalities in the absence of one of the WHO-designated recurring translocations or inversions [ie, t(8,21), inv(16); t(16,16), t(9,11), t(v,11)(v,q23.3), t(6,9), inv(3); or t(3,3), AML with BCR-ABL1].
Defined by the presence of one single monosomy (excluding loss of X or Y) in association with at least one additional monosomy or structural chromosome abnormality (excluding core binding factor AML).
These markers should not be used as an adverse prognostic marker if they cooccur with favorable-risk AML subtypes.
TP53 mutations are significantly associated with AML with complex and monosomal karyotypes.