Combined Molecular and Clinical Prognostic Index for Relapse and Survival in Cytogenetically Normal Acute Myeloid Leukemia

Pastore, Friederike; Dufour, Annika; Benthaus, Tobias; Metzeler, Klaus H.; Maharry, Kati; Schneider, Stephanie; Ksienzyk, Bianka; Mellert, Gudrun; Zellmeier, Evelyn; Kakadia, Purvi M.; Unterhalt, Michael; Feuring‐Buske, Michaela; Buske, Christian; Braess, Jan; Sauerland, Maria Cristina; Heinecke, Achim; Krug, Utz; Berdel, Wolfgang E.; Buechner, Thomas; Woermann, Bernhard J.; Hiddemann, Wolfgang; Bohlander, Stefan K.; Marcucci, Guido; Spiekermann, Karsten; Bloomfield, Clara D.; Hoster, Eva

doi:10.1200/jco.2013.52.3480

Cited by 92 publications

(61 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…[16,17] A point of 1 was assigned to ECOG PS score ≤ 1 at diagnosis, WBC < 50 × 10 9 /L at diagnosis, LDH less than UNL at diagnosis, favorable-risk cytogenetics at diagnosis, or remission after induction. A point of 2 was assigned to age from 60 to 69 years at diagnosis, 1 to 2 times UNL of LDH at diagnosis, BM blasts of 20% to 79% at diagnosis, or intermediate-risk cytogenetics at diagnosis.…”

Section: Resultsmentioning

confidence: 99%

The outcome and prognostic factors of 248 elderly patients with acute myeloid leukemia treated with standard-dose or low-intensity induction therapy

Chen

Yang²,

Zheng³

et al. 2016

Medicine

View full text Add to dashboard Cite

The prognosis of elderly patients with acute myeloid leukemia (AML) is poor, and the recommendation of standard-dose or low-intensity induction regimen for these patients remains controversial. We retrospectively analyzed treatment outcome and prognostic factors of elderly AML patients who had received either standard-dose or low-intensity induction regimens.Two hundred forty-eight elderly AML patients with good Eastern Cooperative Oncology Group performance status (ECOG PS ≤ 2) received one of three regimens for induction in this study: standard-dose cytarabine plus idarubicin (IA; n = 144) or daunorubicin (DA; n = 42); low-intensity cytarabine, aclarubicin, and granulocyte colony-stimulating factor (G-CSF) (CAG; n = 62).After first induction treatment cycle, the overall complete remission (CR) rate was 42.7%. Patients in IA group had a higher CR rate than in DA or CAG group (49.3%, 35.7%, and 32.3%, respectively; P = 0.046). The 1-year, 3-year, and 5-year overall survival (OS) rates were 42.2%, 18.9%, and 13.5% for these 248 patients, with median survival of 9.2 months. Long-term survival of IA group was better than DA or CAG group. The 1-year, 3-year, and 5-year OS rates of IA group were 45.9%, 23.5%, and 19.4%, respectively, as compared to 39.8%, 8.3%, and estimated 2.4% in DA group, and 34.9%, 15.9%, and 6.3% in CAG group, respectively. Early induction mortality and 2-year relapse rates showed no difference among 3 groups. Univariate analysis and multivariate analysis identified lactic dehydrogenase (LDH) more than two times of upper normal limit at diagnosis and nonremission after first induction cycle as adverse prognostic factors for OS. A simple and valid scoring model was constructed for risk stratification and prediction of long-term survival of elderly AML patients.Standard-dose IA regimen could improve the prognosis of elderly AML patients with good performance status compared with standard-dose DA or low-intensity CAG regimen. All prognostic factors and risk assessment should be considered to ensure that each patient receives the suitable individualized treatment.

show abstract

Section: Resultsmentioning

confidence: 99%

The outcome and prognostic factors of 248 elderly patients with acute myeloid leukemia treated with standard-dose or low-intensity induction therapy

Chen

Yang²,

Zheng³

et al. 2016

Medicine

View full text Add to dashboard Cite

show abstract

“…The implementation of risk scores has recently become popular in the field of medicine. In a recently published paper by Pastore et al ., prognostic indices for AML were developed for improvement of individual patient care . For better risk assessment of HCC in patients with chronic hepatitis B, Yang et al .…”

Section: Discussionmentioning

confidence: 99%

Novel score for prediction of malignant bile duct obstruction based on biochemical and clinical markers

Meister

Uphoff

Heinecke

et al. 2015

Aliment Pharmacol Ther

View full text Add to dashboard Cite

Summary Background Early differentiation of malignant from benign bile duct obstruction is of utmost importance. Aim To identify biochemical and clinical predictors for malignancy in patients with bile duct obstruction, and establish a predictive model by combining pre‐treatment patient characteristics. A web‐based application was developed for easy assessment of malignant bile duct probability (http://www.pmal-score.org). Methods One thousand hundred and thirty‐five patients [median age 66 (52–75) years, 53% male] with bile duct obstruction of various aetiologies were retrospectively evaluated at our tertiary referral centre. Multivariate logistic regression analysis identified factors as independently significant for malignant bile duct obstruction. A predictive risk score was established using ROC analysis and applied to an external validation cohort of 101 patients. Results Three hundred and ninety‐four patients had malignant bile duct obstruction proven by surgery, while in 741 patients benign obstruction was observed. Multivariate analysis identified various clinical factors to be predictive for malignancy. On the basis of eight predictors, a risk score for malignancy was developed [X = 0.025 * [age] + 1.239 * [1 if weight loss, otherwise 0] − 0.235 * [1 if pain, otherwise 0] + 0.649 * [1 if diabetes, otherwise 0] + 0.896 * [1 if jaundice, otherwise 0] + 0.109 * [bilirubin] + 0.0007 * [γ‐GT] + 0.0003 * [AP] − 4.374]: A significant correlation between the predicted malignancy and the actual malignancy was found by ROC (AUC: 0.862; 95% CI 0.838–0.886, P < 0.0001). Conclusions This predictive risk score estimates the risk of malignancy in patients with bile duct obstruction, and it seems to be very accurate. A better prediction enables both earlier diagnosis of malignant obstructive disease and improved management of patients with bile duct obstruction, which may result in reduced morbidity and mortality.

show abstract

“…35,36 In addition, elderly patients with a favorable risk profile have a distinctly better outcome compared with the other cytogenetic and molecular risk groups (Figure 1). 3,37 In this regard, it is of note that in younger adults with favorable genotypes, OS is similar between those who receive an allogeneic HSCT in first CR (CR1) and those who do not, so that in the good-risk patients, the option of an allogeneic HSCT is usually reserved in case leukemia recurs. 33,38,39 Also, autologous stem cell transplant applied in CR1 reduces the probability of relapse, with similar OS results.…”

Section: Comments About Patientmentioning

confidence: 99%

“…Fourth, in a general sense, the molecular features that characterize the risk of AML in middle-aged adults also apply to older adults with AML, 37 although the incidence of unfavorable genotypes is significantly more frequent among older adults. These genetic disease-related features of the leukemia furnish clinically informative prognostic insights and thus may offer useful guidance during the therapeutic treatment of an individual patient.…”

Section: Final Considerationsmentioning

confidence: 99%

How I treat the older patient with acute myeloid leukemia

Ossenkoppele

Löwenberg

2015

Blood

181

151

View full text Add to dashboard Cite

Acute myeloid leukemia (AML) in older patients presents a notable therapeutic challenge to the clinical hematologist. The clinical biology of AML among patients is highly heterogeneous. Interpatient variations are relevant for prognosis and treatment choice. Outcome of treatment for patients of advanced age is often compromised by comorbid conditions and an enhanced susceptibility to toxicities from therapy. Here we present selected clinical vignettes that highlight distinct representative situations derived from clinical practice. The vignettes are specifically discussed in light of the perspective of treating older patients with leukemia. We review the clinical significance of various cytogenetic and molecular features of the disease, and we examine the various currently available treatment options as well as the emerging prognostic algorithms that may offer guidance in regard to personalized therapy recommendations. The dilemmas in tailoring treatment selection in this category of patients with AML are the central theme in this discussion.

show abstract

Combined Molecular and Clinical Prognostic Index for Relapse and Survival in Cytogenetically Normal Acute Myeloid Leukemia

Cited by 92 publications

References 37 publications

The outcome and prognostic factors of 248 elderly patients with acute myeloid leukemia treated with standard-dose or low-intensity induction therapy

The outcome and prognostic factors of 248 elderly patients with acute myeloid leukemia treated with standard-dose or low-intensity induction therapy

Novel score for prediction of malignant bile duct obstruction based on biochemical and clinical markers

How I treat the older patient with acute myeloid leukemia

Contact Info

Product

Resources

About