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00925njm 22002777a 4500 dc Sargas, Claudia author Ayala, Rosa author Larráyoz, María J author Chillón, María C author Rodriguez-Arboli, Eduardo author Bilbao, Cristina author Prados de la Torre, Esther author Martínez-Cuadrón, David author Rodríguez-Veiga, Rebeca author Boluda, Blanca author Gil, Cristina author Bernal, Teresa author Bergua, Juan author Algarra, Lorenzo author Tormo, Mar author Martínez-Sánchez, Pilar author Soria, Elena author Serrano, Josefina author Alonso-Dominguez, Juan M author García, Raimundo author Amigo, María Luz author Herrera-Puente, Pilar author Sayas, María J author Lavilla-Rubira, Esperanza author Martinez-Lopez, Joaquin author Calasanz, María J author García-Sanz, Ramón author Pérez-Simón, José A author Gómez Casares, María T author Sánchez-García, Joaquín author Barragán, Eva author Montesinos, Pau author PETHEMA cooperative study group author 2023-05-12 Next-Generation Sequencing is needed for the accurate genetic risk stratification of acute myeloid leukemia according to European LeukemiaNet (ELN) guidelines. We validated and compared the 2022 ELN risk classification in a real-life cohort of 546 intensively and 379 non-intensively treated patients. Among fit patients, those aged ?65 years old showed worse OS than younger regardless risk classification. Compared with the 2017 classification, 14.5% of fit patients changed the risk with the 2022 classification, increasing the high-risk group from 44.3% to 51.8%. 3.7% and 0.9% FLT3-ITD mutated patients were removed from the favorable and adverse 2017 categories respectively to 2022 intermediate risk group. We suggest that midostaurin therapy could be a predictor for 3 years OS (85.2% with vs. 54.8% without midostaurin, P = 0.04). Forty-seven (8.6%) patients from the 2017 intermediate group were assigned to the 2022 adverse-risk group as they harbored myelodysplasia (MDS)-related mutations. Patients with one MDS-related mutation did not reach median OS, while patients with ?2 mutations had 13.6 months median OS (P = 0.002). Patients with TP53 � complex karyotype or inv(3) had a dismal prognosis (7.1 months median OS). We validate the prognostic utility of the 2022 ELN classification in a real-life setting providing supportive evidences to improve risk stratification guidelines. Blood Cancer J . 2023;13(1):77. 10.1038/s41408-023-00835-5 2044-5385 Blood cancer journal 37173322 https://hdl.handle.net/20.500.12105/23128 Comparison of the 2022 and 2017 European LeukemiaNet risk classifications in a real-life cohort of the PETHEMA group