Dupriez et al developed a simple scoring system for patients with agnogenic myeloid metaplasia. The authors are from the University of Lille and 2 other medical centers in France.
Patients studied: 195 patients diagnosed from 1962 to 1992.
Adverse prognostic factors for survival (Table 1, page 1015):
(1) age > 60 years
(2) hepatomegaly
(3) unintentional weight loss
(4) low hemoglobin level
(5) low or very high WBC counts
(6) a high percentage of circulating blasts in the peripheral blood
(7) male sex
(8) low platelet count (< 150,000 per µL)
Major causes of death in patients studied:
(1) acute nonlymphocytic leukemia (ANLL)
(2) portal hypertension
Parameters for the Lille score:
(1) hemoglobin
(2) WBC count
|
Parameter
|
Finding
|
Points
|
|
hemoglobin
|
>= 10 g/dL
|
0
|
|
|
< 10 g/dL
|
1
|
|
WBC count
|
> 30 * 10^9/L
|
1
|
|
|
4 * 10^9 – 30 * 10^9/L
|
0
|
|
|
< 4 * 10^9/ L
|
1
|
Lille risk score =
= (points for hemoglobin) + (points for WBC count)
Interpretation:
• minimum score: 0
• maximum score: 2
|
Score
|
Risk Group
|
Median Survival
|
|
0
|
low
|
93 months
|
|
1
|
intermediate
|
26 months
|
|
2
|
high
|
13 months
|
Additional Prognostic Factors
Karyotype:
(1) An abnormal karyotype is associated with worse prognosis.
(2) In patients in the low risk group, the median survival with a normal karyotype was 112 months but only 50 months with an abnormal karyotype.
Prognostic factors associated with a short time to death from acute nonlymphocytic leukemia:
(1) WBC count > 30 * 10^9/L
(2) abnormal karyotype
Prognostic factors associated with a short time to death from portal hypertension:
(1) circulating blasts > 2%
(2) weight loss
(3) WBC count > 30 * 10^9/L
(4) hepatomegaly
(5) spleen >= 10 cm below the costal margin
