The risk of early mortality in elderly patients with newly diagnosed acute myeloid leukemia.

Chia‐Jen Liu,Jyh‐Pyng Gau,Chiu‐Mei Yeh,Hao‐Yuan Wang,Yao‐Chung Liu,Chun‐Kuang Tsai,Po‐Shen Ko,Po‐Min Chen,Ying‐Chung Hong,Jin‐Hwang Liu,Liang‐Tsai Hsiao,Ai Seon Kuan

doi:10.1002/cam4.2740

Abstract

BackgroundAcute myeloid leukemia (AML) is a common hematologic neoplasm with high incidence and mortality in the elderly. Our aims were to explore risk factors for early mortality in elderly AML patients and develop a new prognostic score.MethodsWe enrolled newly diagnosed AML patients age 60 and above at Taipei Veterans General Hospital between July 2008 and May 2017. The primary endpoint was early mortality, defined as death within two months after AML diagnosis. A multivariate Cox proportional hazards model was used to build a risk‐scoring system incorporating significant risk factors for AML.ResultsThe final cohort included 277 elderly AML patients. The median age was 74 (range 60‐96), and 61.7% were male. The two‐month mortality rate was 29.9%. Age ≥ 80 (adjusted HR 1.88), myocardial infarction (adjusted HR 1.87), ECOG ≥ 2 (adjusted HR 2.10), complex karyotype (adjusted HR 3.21), bone marrow blasts ≥ 70% (adjusted HR 1.88), WBC ≥ 100 × 109/L (adjusted HR 3.31), and estimated glomerular filtration rate (eGFR) < 45 (adjusted HR 2.60) were identified as independent predictors for early mortality in the multivariate analysis. A simplified score incorporating the seven factors was developed with good predictive ability measured by Harrell's C statistic [0.72 (95% CI 0.66‐0.78)].ConclusionsWe identified seven potential risk factors for early mortality and built up a new prognostic score for elderly AML patients. The new score may help clinicians stratify patients and initiate appropriate management. Further validation of our findings on other cohorts is warranted.

Highlights

Acute myeloid leukemia (AML) is a hematological neoplasm commonly seen in Taiwan and many other countries.[1,2] The estimated number of new cases was 21450 in the US in 2019.2 The median age of AML patients at diagnosis is about 70 years old.[3]
We found that age ≥ 80, having an antecedent hematologic disorder, myocardial infarction, ulcer diseases, Eastern Cooperative Oncology Group performance score (ECOG) performance status ≥ 2, complex karyotype, bone marrow (BM) blasts ≥ 70%, WBC count ≥ 100 × 109/L, and estimated glomerular filtration rate (eGFR) < 45 were associated with early mortality in patients with AML (Table 2)
The prognostic index discriminated the risk of early mortality in elderly AML patients with an estimated Harrell's C statistic of 0.74

Summary

Introduction

Acute myeloid leukemia (AML) is a hematological neoplasm commonly seen in Taiwan and many other countries.[1,2] The estimated number of new cases was 21450 in the US in 2019.2 The median age of AML patients at diagnosis is about 70 years old.[3]. They identified age ≥ 80, complex karyotypes, poor performance and elevated creatinine > 1.3 mg/dL as independent predictors for eight-week mortality.[7] Walter et al reviewed 2238 adults treated at MD Anderson Cancer Center and 1127 patients from 10 SWOG trials They found that old age, poor performance status, and low platelet count were risk factors of early death after induction therapy for newly diagnosed AML.[8] Ramos et al conducted a retrospective study (ALMA Registry) in Spain and developed the European ALMA score (using ECOG, WBC, and cytogenetics) to predict OS of unfit AML patients treated with an HMA. Further validation of our findings on other cohorts is warranted

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