A patient undergoing intensive chemotherapy for acute myeloid leukemia may experience increased morbidity and mortality. Sasaki et al reported a score for identifying a patient with a high mortality rate who might benefit from alternative management. The authors are from University of Texas MD Anderson Cancer Center.
Patient selection: acute myeloid leukemia undergoing intensive chemotherapy (cytarabine based), from 15 to 99 years of age
Parameters:
(1) age of the patient in years
(2) therapy-related myeloid neoplasm
(3) antecedent history of dysplasia (MDS or MPN)
(4) ECOG performance status
(5) cardiac comorbidity
(6) white blood cell count per microliter
(7) hemoglobin in g/dL
(8) platelet count per microliter
(9) serum creatinine in mg/dL
(10) serum LDH as multiple of upper limit of normal (ULN)
(11) core binding factor
(12) cytogenetics
(13) infection at diagnosis (exclude fever of unknown origin)
|
Parameter
|
Finding
|
Points
|
|
age of the patient
|
< 40 years
|
0
|
|
|
40 to 64 years
|
1
|
|
|
65 to 74 years
|
2
|
|
|
>= 75 years
|
3
|
|
therapy related
|
no
|
0
|
|
|
yes
|
1
|
|
antecedent MDS or MPN
|
no
|
0
|
|
|
yes
|
1
|
|
ECOG
|
0 to 2
|
0
|
|
|
3 or 4
|
2
|
|
cardiac comorbidity
|
no
|
0
|
|
|
yes
|
1
|
|
WBC count
|
<= 30,000 per µL
|
0
|
|
|
> 30,000 per µL
|
1
|
|
hemoglobin
|
>= 8.0 g/dL
|
0
|
|
|
< 8.0 g/dL
|
1
|
|
platelet count
|
>= 20,000 per µL
|
0
|
|
|
< 20,000 per µL
|
1
|
|
serum creatinine
|
< 1.3 mg/dL
|
0
|
|
|
>= 1.3 mg/dL
|
1
|
|
serum LDH
|
<= 2 times ULN
|
0
|
|
|
> 2 times ULN
|
1
|
|
cytogenetics
|
diploid or Y-
|
0
|
|
|
core bindings factors
|
-2
|
|
|
complex
|
2
|
|
|
other
|
1
|
|
infection at diagnosis
|
no
|
0
|
|
|
yes
|
1
|
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score -2
• maximum score: 16
|
Total Score
|
Prognostic Group
|
5-Year Survival
|
|
-2 to 0
|
favorable
|
67-69%
|
|
1 to 3
|
intermediate
|
36%
|
|
4 to 6
|
poor
|
11-13%
|
|
>=7
|
very poor
|
3%
|
