How is the risk pattern in acute myeloid leukemia (AML) determined?

Updated: May 26, 2020
  • Author: Karen Seiter, MD; Chief Editor: Emmanuel C Besa, MD  more...
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The risk pattern in AML is determined not only by cytogenetic abnormalities (eg, chromosomal translocations, deletions, or duplications) but also by molecular mutations that lead to over- or under-expressions of proteins. [25, 112] See Table 3, below.

Table 3 AML Cytogenetic Risk Factors (Open Table in a new window)

Risk Group

Cytogenetic Abnormality


t(8;21)(q22;q22.2); RUNX1-RUNX1T1

inv(16)(p13.1q22) or t(16;16)(p13.1q22); CBFB-MYH11 

Biallelic mutated CEBPA

Mutated NPM1 without FLT3-ITD or with FLT3-ITDlow 

Intermediate Risk

Mutated NPM1 and FLT3-ITDhigh

Wild-type NPM1 without FLT3-ITD or with FLT3- ITDlow  (without adverse risk genetic lesions)

t(9;11)(p21.3;q23.3); MLLT3-KMT2A

Cytogenetic abnormalities not classified as favorable or adverse

Poor Risk

t(6;9)(p23;q34.1); DEK-NUP214

t(v;11q23.3); KMT2A rearranged

t(9;22)(q34.1;q11.2); BCR-ABL1

inv(3)(q21.3q26.2) or t(3;3)(q21.3;q26.2); GATA2MECOM (EVI1)

-5 or del(5q); -7; -17/abn(17p)

Complex karyotype, monosomal karyotype

Wild type NPM1 and FLT3- ITDhigh

Mutated RUNX1

Mutated ASXL1

Mutated TP53


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