Risk Stratification
Risk stratification helps doctors predict how your disease might behave and choose the best treatment approach for you.
What is Risk Stratification?
Risk stratification is the process of categorizing patients into groups based on the likely course of their disease. It's not about blame or faultβit's a scientific tool to personalize treatment.
The Three Risk Categories
β Favorable Risk
Better response to standard chemotherapy expected. May not require a stem cell transplant in first remission. Examples: NPM1 mutation without FLT3-ITD, certain chromosome changes like t(8;21).
β οΈ Intermediate Risk
Treatment decisions are often individualized. A stem cell transplant may be considered based on other factors.
β‘ Adverse Risk
More intensive approaches often recommended, including stem cell transplant. Clinical trials may offer promising options. Examples: TP53 mutations, complex karyotype.
Factors That Determine Risk
- Genetic mutations: Specific gene changes in your cancer cells
- Chromosome changes: Also called cytogenetics or karyotype
- Response to initial treatment: How quickly the disease responds
- Patient factors: Age and overall health
π‘ Important to Remember
Risk categories are based on statistics from many patients. Your individual journey may differ. Always discuss your specific situation with your medical team.
The ELN 2022 Classification
Doctors use standardized guidelines to classify AML risk. The most current is the ELN 2022 (European LeukemiaNet 2022) classification, which considers both genetic mutations and chromosome changes.
Key Changes in ELN 2022:
- β’Added MRD assessment as a factor in determining risk after treatment begins
- β’Recognizes more favorable mutations including bZIP CEBPA mutations
- β’Considers FLT3-ITD allelic ratio no longer a factor for risk category
- β’New adverse-risk genetic markers including MECOM rearrangements
MRD: Minimal Residual Disease
MRD (Minimal Residual Disease) refers to tiny amounts of cancer cells that remain after treatmentβtoo few to detect with standard tests. MRD status is increasingly used to refine your risk category.
MRD Negative
No detectable leukemia cells with sensitive tests. Associated with better outcomes and may influence transplant decisions.
MRD Positive
Some leukemia cells still detectable. May indicate a higher risk of relapse and could prompt more intensive treatment.
MRD is typically measured using flow cytometry or PCR testing at specific time points during treatment.
What Happens After Risk Assessment?
Your risk category helps guide the next steps in your treatment plan:
- Favorable risk: May receive chemotherapy alone in first remission, with transplant reserved if disease returns
- Intermediate risk: Treatment decisions weigh MRD status, age, fitness, and donor availability
- Adverse risk: Stem cell transplant often recommended in first remission; clinical trials may offer best options
π Learn More
Blood Cancer United explains treatment outcomes and what influences them.
AML Treatment Information at Blood Cancer United