Perspectives on acute myeloid leukemia diagnosis: a comparative analysis of the latest World Health Organization and the International Consensus Classifications

Abstract This study compares and analyzes the 5th edition of the WHO classification (WHO 2022) and the International Consensus Classification (ICC) in the context of 861 acute myeloid leukemia (AML) patients from Seoul St. Mary's Hospital. Using WHO 2022, 154 patients were reclassified from WHO 2016, including 23 with KMT2A rearrangement and additional 23 with other genetic abnormalities. AML myelodysplasia-related (AML-MR) category was significantly affected by the WHO 2022, with 8.2% reclassified from AML with RUNX1 mutation and 15.2% from AML-not otherwise specified when the majority of them were from AML-myelodysplasia related changes (AML-MRC) according to WHO 2016. AML-MR showed significantly worse survival outcomes than AML defined by differentiation. Among the AML-MR subgroup, patients with a history of myelodysplastic syndrome or myelodysplastic syndrome/myeloproliferative disorder had a poorer prognosis compared to AML-MR defined by mutation and/or cytogenetics. ICC adopted three categories associated with AML-MRC: 34 patients with AML with mutated TP53 , 169 with AML-MR-gene mutations, and 67 with AML-MR-cytogenetic abnormalities among included patients. AML with mutated TP53 , mostly from AML-MRC, was an unfavorable subtype with poor prognostic outcomes. Our evaluation supports the refinements made in WHO 2022 and ICC of AML and proposes additional refinements to provide more accurate prognostic information.