A Scoring System To Predict The Risk Of Death During Induction

Chemotherapy For De Novo Acute Myeloid Leukemia.

1David Valcárcel, 2Pau Montesinos, 3Isabel Sánchez-Ortega, 1Salut Brunet, 4Jordi Esteve, 2David M. Cuadrón, 5José M. Ribera, 6Mar Tormo, 7Javier

Bueno, 8Rafael Duarte, 9Andrés Llorente, 10P. Torres, 11Ramón Guardia, 2Miguel A Sanz, and 1Jorge

Sierra; on behalf of the CETLAM Group.

Background

• Induction chemotherapy of acute myeloid leukemia (AML), the first step to cure this disease, is associated to substantial mortality due to infections, hemorrhages

• up to 10-20% of patients die during induction phase

• the identification of patients at high risk of induction death (ID) may allow the individualization of the chemotherapy regimens and supportive measures 2

Background

• risk factors associated to higher rates of ID older age, high leukocyte count, and bad performance status

• only few studies designed to build scoring systems to predict accurately the risk of ID

• often including a high number of variables and may not be easy to use in the daily clinical practice

• none has been validated in an external cohort of AML patients

Objectives

• identify the risk factors for ID in a large cohort of 570 consecutive patients treated between 1999 and 2006 in 20 Spanish centers of the CETLAM group

• Using these risk factors, we aim to build a scoring system to predict ID

• The external validity of the scoring system was tested in an independent set of patients from a single institution

Performance status / ComorbilidadSuperv. Global

Grupo ECOG Baja

Charlson comorbidity index (CCI) Baja

Hematopoietic cell transplantation comorbidity index (HCT-CI) Baja

Estado general y Pronóstico tras QT intensiva en pacientes mayores de 60-70 años con SMD/LMA

Tasa de RC

Baja

Baja

ND

No. Ptes

998

133

177

Kantarjian H, et al. Cancer 2006; 106:1090-1198.Etienne A, et al. Cancer 2007; 109:1376-1383.Giles FJ, et al. Br J Haematol 2007; 136:624-627.

SG tras QT intensivaen LMA/SMD según HCT-CI

GilesFJ, et al. Br J Haematol 2007; 136:624-627.

Methods and Patients

• 570 patients included in two multicenter trials of the CETLAM Group to develop a scoring system (study cohort)

• The scoring system was tested in 209 consecutive patients from an external single institution (validation cohort)

• induction regimens consisted of anthracycline and cytarabine combination with or without etoposide

• ID was defined as death in the first 42 days without evidence of leukemic resistance.

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Figure 1Figure 1

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Figure 2Figure 2

Conclusions

• our validated scoring system allows easy risk stratification for ID in the clinical setting

• However, our scoring system is not optimal for the risk-adapted implementation of specific supportive measures

Conclusions

• may be helpful to design risk-adapted induction strategies

• But patient selection depends also on some variables predicting ID (comorbidities, PS, and other)

• leukemic characteristics affecting the chances to achieve a CR (cytogenetics and FLT3-ITD mutations), as well as other circumstances (e.g., patient, family and physician preferences), will also influence the patient selection