Prognostic factor analysis of the survival of elderly patients with AML in the MRC AML11 and LRF AML14 trials

Abstract

Summary This analysis, of 2483 patients with acute myeloid leukaemia (AML) aged 60+ years entered into two UK trials, was performed to determine the baseline parameters related to survival and to develop a risk index. The Medical Research Council (MRC) AML11 trial (n = 1071) was used to develop the index; this was validated using data from the Leukaemia Research fund (LRF) AML14 trial on 1137 intensively (AML14I) and 275 non‐intensively (AML14NI) treated patients. In AML11, cytogenetic group, age, white blood count, performance status and type of AML (de novo, secondary) were all highly significantly related to prognosis in multivariate analysis. The regression coefficients were used to define good, standard and poor risk groups, with 1‐year survival of 53%, 43% and 16% respectively (P < 0·0001). The risk index showed very good discrimination in both AML14I and AML14NI (both P < 0·0001), thereby providing validation, although survival in all groups was very poor in AML14NI. The risk factors for survival in older AML patients were similar to those in younger ones and discrimination of patient groups with relatively good to very poor prognosis was possible. These risk groups apply to both intensively and non‐intensively treated patients. Randomized trials of intensive versus non‐intensive therapy are needed to determine which types of patient should be given which type of treatment.

Characterization and prognostic features of secondary acute myeloid leukemia in a population‐based setting: A report from the Swedish Acute Leukemia Registry

“…The proportion of patients with secondary AML found in our study (26.4%) was also higher compared to most previous studies [3,[20][21][22]. The proportion of patients with t-AML (7.7%) is slightly higher compared to most other studies [2,3,7,[19][20][21], which could be due to our rigorous reporting of the primary disease, also including nonmalignant diseases treated by chemotherapy and/or radiation.…”

Comparison of epigenetic versus standard induction chemotherapy for newly diagnosed acute myeloid leukemia patients ≥60 years old

“…Since then, multiple models prognosticating the outcomes of older AML patients receiving IC have been developed. While there are some differences, the cornerstone of all of these models remain age, performance status, and cytogenetics [7,47]. Tools to more accurately judge the fitness of older AML patients independent of chronological age have been developed.…”

Risk stratification using a new prognostic score for patients with secondary acute myeloid leukemia: results of the prospective AML96 trial

“…In AML, general prognostic factors, such as age and cytogenetics, have been well established; however, for patients with sAML, there are no prognostic risk stratification models available. 7 Owing to progress in elucidating the impact of cytogenetic and molecular markers and therefore combining biological and clinical data for prognosis and treatment outcomes, the aim of this retrospective analysis was to provide a prognostic scoring system by including clinical and laboratory data from patients being treated in the prospective AML96 trial of the Study Alliance Leukemia (SAL) study group. Furthermore, verification of the applicability of this prognostic score by validation in an independent test set of patients was performed.…”