Comorbidity is an independent predictor of complete remission in elderly patients receiving induction chemotherapy for acute myeloid leukemia

Abstract

BACKGROUND.Elderly patients with acute myeloid leukemia (AML) have a poor prognosis, which is explained by the disease itself and by host‐related factors. The objective of this study was to determine the prognostic role of comorbidities in this population.METHODS.For this single‐center, retrospective study, the authors analyzed the outcome of 133 patients aged ≥70 years who received induction chemotherapy for nonpromyelocytic AML between 1995 and 2004. Comorbidities were evaluated by using an adapted form of the Charlson comorbidity index (CCI).RESULTS.The median patient age was 73 years. The CCI score was 0 for 83 patients (68%), 1 for 16 patients (13%), and >1 for 23 patients (19%). The complete remission (CR) rate was 56%, and the median overall survival was 9 months. In multivariate analysis, 4 adverse prognostic factors for CR were identified: unfavorable karyotype, leukocytosis ≥30 g/L, CD34 expression on leukemic cells, and CCI >1. A score could be generated to allow the stratification of patients into low‐, intermediate‐, and high‐risk groups with CR rates of 87%, 63%, and 37%, respectively. The risk of early mortality and the probability of survival also were different in the 3 risk groups (P = .02 and P = .01, respectively).CONCLUSIONS.The results from this study indicated that associated comorbidities are independent factors that may influence achievement of CR in elderly patients with AML. Such a scoring system may be useful in the prognostic staging systems that are used to identify patients with AML who can benefit from induction chemotherapy. Cancer 2007. © 2007 American Cancer Society.

Age and acute myeloid leukemia: real world data on decision to treat and outcomes from the Swedish Acute Leukemia Registry

“…The PS classification does not differentiate between functional impairment resulting from leukemia, which is reversible with intensive treatment, compared with irreversible comorbidity unrelated to leukemia. Therefore, comorbidity scoring 38 may have a greater potential for providing basis for treatment decisions than PS 39 but has not been recorded in the Swedish registry previously. It is obvious from our tables and figures that age and PS are independently influencing outcomes.…”

Risk factors and decision criteria for intensive chemotherapy in older patients with acute myeloid leukemia

“…For instance, a refined Hematopoetic Cell Transplantation Comorbidity Index (HCTCI) was recently developed in patients who were candidates for allogeneic stem cell transplantation, 8 and then successfully tested in older patients with AML. 9,10 However, poor risk factors could be suboptimal decision tools at the level of individual patients. Indeed, a very potent risk factor in terms of hazard ratio (HR) and p value may be a poor discriminating factor if associated with a low specificity and high false positive rate (FPR).…”

“…Only high-risk cytogenetics reached the target in terms of specificity (FPR <10%). This factor could, therefore, be considered as a good decisional criterion to advise against intensive chemotherapy by itself, since it discriminated 12% of patients who had an estimated overall survival of only 9% at 12 months (95% CI, [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] while it was detected in only 2% of the survivors.…”

To transplant or not: a dilemma for treatment of elderly AML patients in the twenty-first century

“…15 Higher HCT-CI scores are associated with higher mortality. 12,[16][17][18][19] An MDACC study in 177 elderly AML patients (age 460) showed that early date rates were 3%, 11%, and 29% in patients with HCT-CI scores of 0 (n ¼ 39), 1-2 (n ¼ 53) and X3 (n ¼ 85) (Po0.001), respectively. Median OS was inversely affected by higher HCT-CI scores (median OS was 45, 31 and 19 weeks in these three groups, P ¼ 0.04).…”