A new web-based application predicts the probability for complete remission (CR) or early death (ED) after chemotherapy in patients aged 60 years and older with acute myeloid leukemia (AML). The tool, developed by the German Acute Myeloid Leukaemia Cooperative Group and the Study Alliance Leukemia Investigators, can help clinicians weigh the option of intensive induction chemotherapy for older, otherwise healthy patients. In addition, the tool requires only standard clinical data and laboratory variables to calculate the risk scores.
To develop the risk calculator, investigators performed multivariate regression analysis on data from 1406 patients aged 60 years or older with AML. The patients were otherwise medically healthy and had been treated with two courses of either tioguanine/cytarabine/daunorubicin followed by high-dose cytarabine/mitoxantrone or high-dose cytarabine/mitoxantrone in the first and second induction courses. Patients were culled from the German Acute Myeloid Leukaemia Cooperative Group 1999 study. Data from 801 patients from the Acute Myeloid Leukaemia 1996 study were used to validate the risk calculation tool.
Investigators identified clinical variables significantly associated with CR or ED: body temperature, age, de novo leukemia versus secondary leukemia, hemoglobin, platelet count, fibrinogen, and serum concentration of lactate dehydrogenase.
The probability of CR with knowledge of cytogenetic and molecular risk (score 1) was from 12% to 91%, and without knowledge (score 2) was from 21% to 80%. The predicted risk of ED was from 6% to 69% for score 1, and from 7% to 63% for score 2. For the validation cohort, CR for score 1 was from 10% to 91% and for score 2 was from 16% to 80%; ED for score 1 was from 6% to 69%, and for score 2 was from 7% to 61%.