Kantarjian et al identified prognostic factors for a patient >= 65 years of age treated with intensive chemotherapy for acute myeloid leukemia (AML) or high-risk myelodysplastic syndrome (MDS). These can determine the chances of achieving a complete response. The authors are from the University of Texas M.D. Anderson Cancer Center.
Patient selection:
(1) age >= 65 years
(2) AML or high-risk MDS
Complete response has all of the following:
(1) normalization of the bone marrow morphology
(2) less than 5% blasts
(3) peripheral absolute granulocyte count >= 1,000 per µL
(4) peripheral platelet count >= 100,000 per µL
Parameters:
(1) age
(2) history of previous therapy for another cancer
(3) duration of antecedent hematologic disorder in months
(4) treatment outside a laminar airflow room
(5) karyotype
(6) WBC count
(7) hemoglobin
(8) serum creatinine
(9) ECOG performance scale
|
Parameter |
Findings |
Points |
|
age in years |
< 75 years |
0 |
|
|
>= 75 years |
1 |
|
history of previous therapy for another cancer |
no |
0 |
|
|
yes |
1 |
|
duration of antecedent hematologic disorder |
< 6 months |
0 |
|
|
>= 6 months |
1 |
|
treatment outside a laminar airflow room |
no |
0 |
|
|
yes |
1 |
|
karyotype |
favorable or intermediate |
0 |
|
|
unfavorable (noncomplex or complex) |
1 |
|
WBC count |
< 25,000 per µL |
0 |
|
|
>= 25,000 per µL |
1 |
|
hemoglobin |
> 8 g/dL |
0 |
|
|
<= 8 g/dL |
1 |
|
serum creatinine |
<= 1.3 mg/dL |
0 |
|
|
> 1.3 mg/dL |
1 |
|
ECOG performance scale |
0 or 1 or 2 |
0 |
|
|
3 or 4 |
1 |
where:
• A favorable karyotype has t(8; 21) or an inversion 16 (alone or with other changes).
• An intermediate karyotype is normal diploid or with loss of chromosome Y (in a male).
• A noncomplex karyotype shows 1 or 2 cytogenetic abnormalities.
• A complex karyotype shows 3 or more cytogenetic abnormalities.
total score =
= SUM(points for all 9 parameters)
Interpretation:
• minimum score: 0
• maximum score: 9
• The higher the score the greater the risk.
|
Total Score |
Probability of a Complete Response |
|
0 or 1 |
73% |
|
2 or 3 |
47% |
|
4 to 9 |
18% |
Specialty: Hematology Oncology
ICD-10: ,
