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
Parameters for mortality during the 8 week induction period:
(1) age
(2) duration of antecedent hematologic disorder in months
(3) treatment outside a laminar airflow room
(4) karyotype
(5) serum creatinine
(6) ECOG performance scale
|
Parameter |
Findings |
Points |
|
age in years |
< 75 years |
0 |
|
|
>= 75 years |
1 |
|
duration of antecedent hematologic disorder |
< 12 months |
0 |
|
|
>= 12 months |
1 |
|
treatment outside a laminar airflow room |
no |
0 |
|
|
yes |
1 |
|
karyotype |
favorable or intermediate or noncomplex |
0 |
|
|
complex |
1 |
|
serum creatinine |
<= 1.3 mg/dL |
0 |
|
|
> 1.3 mg/dL |
1 |
|
ECOG performance scale |
0 or 1 |
0 |
|
|
2 or 3 or 4 |
1 |
Parameters for survival:
(1) age
(2) duration of antecedent hematologic disorder in months
(3) treatment outside a laminar airflow room
(4) karyotype
(5) serum creatinine
(6) ECOG performance scale
(7) serum lactate dehydrogenase
|
Parameter |
Findings |
Points |
|
age in years |
< 75 years |
0 |
|
|
>= 75 years |
1 |
|
duration of antecedent hematologic disorder |
< 12 months |
0 |
|
|
>= 12 months |
1 |
|
treatment outside a laminar airflow room |
no |
0 |
|
|
yes |
1 |
|
karyotype |
favorable or intermediate |
0 |
|
|
unfavorable (noncomplex or complex) |
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 |
|
serum LDH |
<= 600 IU/L |
1 |
|
|
> 600 IU/L |
0 |
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.
• The reference range for serum LDH was not given.
total score for mortality during 8 week induction period =
= SUM(points for all 6 parameters)
total score for overall survival =
= SUM(points for all 7 parameters)
Interpretation:
• minimum score for mortality during 8 week induction or overall survival: 0
• maximum score for mortality during 8 week induction: 6
• maximum score for survival: 7
• The higher the score the greater the risk.
|
Total Score for Mortality During Induction |
Risk Group |
Probability of Mortality During Induction |
|
0 |
low |
10% |
|
1 |
intermediate |
19% |
|
2 |
intermediate |
36% |
|
3 to 6 |
high |
65% |
|
Total Score for Survival |
Median Survival |
Probability of 2 Year Survival |
|
0 |
18 months |
35% |
|
1 or 2 |
7 months |
19% |
|
3 to 7 |
1 month |
3% |
Specialty: Hematology Oncology
ICD-10: ,
