Premium
Treating octogenarian and nonagenarian acute myeloid leukemia patients—Predictive prognostic models
Author(s) -
Harb Antoine J.,
Tan Wei,
Wilding Gregory E.,
Ford LaurieAnn,
Sait Sheila N. J.,
Block AnneMarie W.,
Barcos Maurice,
Wallace Paul K.,
Wang Eunice S.,
Wetzler Meir
Publication year - 2009
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.24285
Subject(s) - medicine , comorbidity , myeloid leukemia , retrospective cohort study , multivariate analysis , cohort , prospective cohort study , survival rate
BACKGROUND: Treating the octogenarian and nonagenarian patients who have acute myeloid leukemia (AML) with intensive chemotherapy is controversial. Several models to predict outcome were proposed, including the use of a comorbidity index. However, it is unclear whether the Charlson comorbidity index (CCI) or the hematopoietic cell transplant comorbidity index (HCTCI) is more sensitive. METHODS: The authors analyzed their experience with 92 patients aged ≥80 years who had AML. Patients' pretreatment characteristics and their treatment outcomes were recorded. RESULTS: All patients were offered intensive treatment; 59 patients (64%) were treated intensively with a variety of regimens, whereas 33 patients (36%) elected to receive supportive care. The CCI and the HCTCI had similar predictive ability for outcome in both groups. A multivariate analyses of prognostic factors identified near‐normal albumin (48% of patients; 1‐year survival rate, >27%) as a favorable factor for the whole cohort, age <83 years (47% of patients; 1‐year survival rate, >25%) and nonmonocytic morphology (75% of patients; 1‐year survival rate, >26%) as favorable factors for the intensively treated cohort, and bone marrow blasts <46% (50% of patients; 1‐year survival rate, >19%) as a favorable factor for patients who received supportive care. CONCLUSIONS: This retrospective analysis was developed to assist in treatment decisions for octogenarian and nonagenarian patients with AML. The findings will need validation in a prospective study. Cancer 2009. © 2009 American Cancer Society.