Etienne et al identified factors affecting an elderly patient's chance of achieving a complete remission following induction chemotherapy for acute myeloid leukemia (AML). This can help identify patients who may require more aggressive management. The authors are from Paoli-Calmettes Institute in Marseille, France.
Patient selection: adult > 65 years of age with AML
Parameters:
(1) white blood cell count
(2) CD34 expression
(3) karyotype
(4) Charlson comorbidity index (CCI)
|
Parameter |
Finding |
Points |
|
white blood cell count |
< 30,000 per µL |
0 |
|
|
>= 30,000 per µL |
1 |
|
CD34 expression |
negative |
0 |
|
|
positive |
1 |
|
karyotype |
favorable |
0 |
|
|
unfavorable |
1 |
|
Charlson comorbidity index |
0 or 1 |
0 |
|
|
>= 2 |
1 |
where:
• Unfavorable karyotypes: deletion 5q, deletion 7q, 11q23 rearrangements, complex karyotype with >= 3 abnormalities.
• Favorable karyotype: inversion 16, t(8:21)(q22:q22)
• Intermediate karyotype = not favorable and not unfavorable.
• In the text the handling of intermediate risk karyotype is a bit ambiguous. The risk score is based on the presence or absence of an unfavorable karyotype. However, the odds ratio for complete remission with an intermediate karyotype is comparable to the other 3 risk factors (see Table 4, page 1381).
• One variation might be to score the intermediate group as 0.5, and make intermediate risk 1.5 - 2.5.
total risk score =
= SUM(points for all 4 parameters)
Interpretation:
• minimum risk score: 0
• maximum risk score: 4
• The higher the risk score the greater the risk to the patient, with lower rates of complete remission and increased mortality rate.
|
Total Score |
Risk Group |
Complete Remission |
2 Year Overall Survival |
|
0 or 1 |
low |
87% |
53% |
|
2 |
intermediate |
63% |
27% |
|
3 or 4 |
high |
37% |
15% |
Specialty: Hematology Oncology
