Razzouk et al identified risk factors associated with outcome in children with acute myeloid leukemia. This can help identify patients who may benefit from more aggressive management. The authors are from St. Jude Children's Research Hospital and M.D. Anderson Cancer Center.
Patient selection: pediatric patient with acute myeloid leukemia (AML)
Parameters associated with overall survival:
(1) age of the patient in years
(2) cytogenetic risk group
(3) white blood cell (WBC) count at the time of diagnosis
(4) French American British (FAB) group
Cytogenetic risk groups:
(1) poor: (-7), (-5), del(5q), abnormal 3q, complex karyotype
(2) favorable: inv(16), t(16;16), t(9;11), t(8;21), Down's syndrome
(3) intermediate group: normal cytogenetics, not poor or favorable
|
Parameter |
Finding |
Hazard Ratio |
|
age of the patient years |
<10 years of age |
1 |
|
|
>= 10 years of age |
1.6 |
|
cytogenetic group |
favorable |
1 |
|
|
intermediate |
2.1 |
|
|
adverse |
3.2 |
|
WBC count |
<= 50,000 per µL |
1 |
|
|
> 50,000 per µL |
1.4 |
|
FAB group |
M7 |
1 |
|
|
other |
2.7 |
where;
• Therapy before 1990 was also a variable in multivariate analysis, but would not apply today.
This data can be developed into a risk score (proposed score not included in paper below, or the hazard ratios can be multiplied together.
|
Parameter |
Finding |
Points |
|
age of the patient years |
<10 years of age |
0 |
|
|
>= 10 years of age |
1 |
|
cytogenetic group |
favorable |
0 |
|
|
intermediate |
1 |
|
|
adverse |
2 |
|
WBC count |
<= 50,000 per µL |
0 |
|
|
> 50,000 per µL |
1 |
|
FAB group |
M7 |
0 |
|
|
other |
2 |
total number of points =
= SUM(points for all 4 factors)
Interpretation:
• minimum sum score: 0
• maximum sum score: 6
• minimum product of hazard ratios: 1
• maximum product of hazard ratios: 19.4
Specialty: Hematology Oncology
