Prediction of Early (4-Week) Mortality in Acute Myeloid Leukemia With Intensive Chemotherapy

Authors

Koji Sasaki
Tapan Kadia
Kebede Begna
Courtney D DiNardo
Gautam Borthakur
Nicholas J Short
Nitin Jain
Naval Daver
Elias Jabbour
Guillermo Garcia-Manero
Guillermo Montalban Bravo
Lucia Masarova
Sherry Pierce
Marina Konopleva
Farhad Ravandi
Ayalew Tefferi
Hagop Kantarjian

Publication Date

1-1-2022

Journal

American Journal of Hematology

Abstract

The progress with intensive chemotherapy and supportive care measures has improved survival in patients with newly diagnosed acute myeloid leukemia (AML). Given the recent development of effective low intensity therapies, an optimal decision on the therapy intensity may improve survival through the avoidance of early mortality. We reviewed the outcome of 3728 patients with newly diagnosed AML who received intensive chemotherapy between August 1980 and May 2020. Intensive chemotherapy was defined as a cumulative cytarabine dose ≥ 700 mg/m2 during induction therapy. We divided the whole cohort into a training and validation group at a 3:1 ratio. The population was divided into a training (2790 patients) and a validation cohort (938 patients). The median age was 55 years (range, 15-99). Among them, 442 patients (12%) had core-binding factor AML. Binary logistic regression identified older age, worse performance status, hyperbilirubinemia, elevated creatinine, hyperuricemia, cytogenetic abnormalities other than CBF and -Y, and pneumonia as adverse prognostic factors for an early 4-week mortality. This risk classification for early mortality was verified in the validation cohort of patients. In the validation cohort of more recently treated patients from 2000 to 2017, the 4-week mortality rates with intensive chemotherapy were 2%, 14%, and 50% in the low-, high-, and very high-risk group, respectively. The mortality rates with low intensity therapies were 3%, 9%, and 20%, respectively. The risk classification guides treatment intensity by the assessment of age, frailty, organ dysfunction, cytogenetic abnormality, and infection to avoid early mortality.

Keywords

Adult, Aged, Antineoplastic Combined Chemotherapy Protocols, Female, Humans, Leukemia, Myeloid, Acute, Male, Middle Aged, Multivariate Analysis, Prognosis, Retrospective Studies, Acute myeloid leukemia, intensive chemotherapy, low intensity therapy, early mortality

DOI

10.1002/ajh.26395

PMID

34716921

PMCID

PMC11809073

PubMedCentral® Posted Date

2-10-2025

PubMedCentral® Full Text Version

Author MSS

Published Open-Access

yes