WHO, ELN and IPSS-M: Adjusting Our Diagnostic Service

The year 2022 yielded important advances for the diagnostic and prognostic classifications of hematologic neoplasms. On the one hand, there are the preliminary publications on the new WHO classification and the new ICC (International Consensus Classification). On the other, new ELN guidelines for AML with modifications of the previous risk categories and the IPSS-M score for MDS have been published. The latter, as the successor to the IPSS-R, incorporates molecular genetic alteration into the risk stratification for the first time.

Increasing Complexity Enables More Differentiated Decision-Making Processes

The new WHO classification further advances the paradigm shift “from phenotype to genotype.” The final diagnosis is increasingly based on objectifiable genetic characteristics and less and less for example on the morphological phenotype, which is often only reproducible to a limited extent. An increasing incorporation of molecular genetic features is also occurring in the prognostic characterization of myeloid neoplasms. While the new ELN score allows the risk classification to still be done “by hand” on the basis of a summary table, the IPSS-M factors in the mutation status of 31 genes, including the TP53 allele status, among others. Calculating the IPSS-M score is only possible using an online calculator tool.

Naturally, this places increased demands on you and on us in our everyday diagnostic work, but it also enables more individualized prognoses and therapy planning. We are eagerly awaiting the results of prospective therapy studies based on the new prognostic scores.

Adjustment of the Diagnostic Offerings at MLL

We are of course adapting our diagnostic services to the above-mentioned innovations. We are planning to use the new WHO diagnoses in our findings across the board by early 2023 (after publication of the final WHO version in book form).

The prognostic scores for AML (according to ELN) and MDS (IPSS-M) published in 2022 have already been incorporated in our examination order (https://www.mll.com/en/request-form/mll_request_form.pdf) in the form of specific molecular genetic panels.

Integration of the New Classifications and Scores in Our “Integrated Findings”

Many of you are familiar with MLL’s “Integrated Report” (IR), which provides another interpretation of the examination findings prepared at MLL for MDS and AML cases. It contains the diagnosis according to the WHO, conventional prognostic classifications, and recommendations for any MRD markers or targeted therapies. The Integrated Report is generated by an algorithm and validated by a physician if the required diagnostic methods have been performed in advance at MLL and additional required blood count (MDS) details have been transmitted to us.

Both the modified ELN score for AML as well as the IPSS-M have already been implemented in our Integrated Report to help you manage the increasing flow of diagnostic data. Furthermore, users of our digital order entry system have the option of submitting any missing blood count data via the subsequent request tool included in the system, after which they will receive an IR for MDS cases.

Similar to our standard methods (see above), the diagnoses in the IR will also be adjusted according to the new WHO classification at the beginning of 2023.

The author

»Do you have questions regarding this article or do you need further information? Please send me an e-mail.«

Dr. med. Christian Pohlkamp

Internist, Hematologist and Oncologist
Head of Cytomorphology
Head of Customer Care

T: +49 89 99017-150