A Scoring System To Predict The Risk Of Death During Induction Chemotherapy For De Novo Acute Myeloid Leukemia.

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A Scoring System To Predict The Risk Of Death
During Induction Chemotherapy For De Novo Acute
Myeloid Leukemia.

• 1David Valcárcel, 2Pau Montesinos, 3Isabel
  Sánchez-Ortega, 1Salut Brunet, 4Jordi Esteve,
  2David M. Cuadrón, 5José M. Ribera, 6Mar Tormo,
  7Javier Bueno, 8Rafael Duarte, 9Andrés Llorente,
  10P. Torres, 11Ramón Guardia, 2Miguel A Sanz,
  and 1Jorge Sierra on behalf of the CETLAM Group.

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Background

• Induction chemotherapy of acute myeloid leukemia
  (AML), the first step to cure this disease, is
  associated to substantial mortality due to
  infections, hemorrhages
• up to 10-20 of patients die during induction
  phase
• the identification of patients at high risk of
  induction death (ID) may allow the
  individualization of the chemotherapy regimens
  and supportive measures 2

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Background

• risk factors associated to higher rates of ID ?
  older age, high leukocyte count, and bad
  performance status
• only few studies designed to build scoring
  systems to predict accurately the risk of ID
• often including a high number of variables and
  may not be easy to use in the daily clinical
  practice
• none has been validated in an external cohort of
  AML patients

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Objectives

• identify the risk factors for ID in a large
  cohort of 570 consecutive patients treated
  between 1999 and 2006 in 20 Spanish centers of
  the CETLAM group
• Using these risk factors, we aim to build a
  scoring system to predict ID
• The external validity of the scoring system was
  tested in an independent set of patients from a
  single institution

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Estado general y Pronóstico tras QT intensiva en
pacientes mayores de 60-70 años con SMD/LMA
Performance status / Comorbilidad
Superv. Global
Tasa de RC
No. Ptes
Grupo ECOG
Baja
Baja
998
Charlson comorbidity index (CCI)
Baja
Baja
133
Hematopoietic cell transplantation comorbidity
index (HCT-CI)
Baja
ND
177
Kantarjian H, et al. Cancer 2006
1061090-1198. Etienne A, et al. Cancer 2007
1091376-1383. Giles FJ, et al. Br J Haematol
2007 136624-627.
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SG tras QT intensivaen LMA/SMD según HCT-CI
GilesFJ, et al. Br J Haematol 2007 136624-627.
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Methods and Patients

• 570 patients included in two multicenter trials
  of the CETLAM Group to develop a scoring system
  (study cohort)
• The scoring system was tested in 209 consecutive
  patients from an external single institution
  (validation cohort)
• induction regimens consisted of anthracycline and
  cytarabine combination with or without etoposide
• ID was defined as death in the first 42 days
  without evidence of leukemic resistance.

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Figure 1
Plt0.001
High-risk
Intermediate-risk
Low-risk
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Figure 2
Plt0.001
High-risk
Intermediate-risk
Low-risk
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Conclusions

• our validated scoring system allows easy risk
  stratification for ID in the clinical setting
• However, our scoring system is not optimal for
  the risk-adapted implementation of specific
  supportive measures

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Conclusions

• may be helpful to design risk-adapted induction
  strategies
• But patient selection depends also on some
  variables predicting ID (comorbidities, PS, and
  other)
• leukemic characteristics affecting the chances to
  achieve a CR (cytogenetics and FLT3-ITD
  mutations), as well as other circumstances (e.g.,
  patient, family and physician preferences), will
  also influence the patient selection