Complete remission and early death after intensive chemotherapy in patients aged 60 years or older with acute myeloid leukaemia: a web-based application for prediction of outcomes
Complete remission and early death after intensive chemotherapy in patients aged 60 years or older with acute myeloid leukaemia: a web-based application for prediction of outcomes
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DOI：
10.1016/s0140-6736(10)62105-8
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发表时间：
2010-12-11
期刊：
影响因子：
168.9
通讯作者：
Mueller-Tidow, Carsten
中科院分区：
文献类型：
--
作者：
Krug, Utz;Roellig, Christoph;Mueller-Tidow, Carsten
研究背景：约50%的急性髓性白血病患者（年龄≥ 60岁）在强化化疗后达到完全缓解（CR），但与年轻患者相比，早期死亡（艾德）的风险显著增加。我们验证了标准临床和实验室变量与CR和艾德的相关性，并开发了一个基于网络的应用程序，用于这些患者强化化疗的风险评估。方法采用多变量回归分析，在了解或不了解1406例患者的细胞遗传学和分子风险特征的情况下，开发风险评分（年龄>= 60岁）急性髓性白血病患者，但其他医学健康，接受了两个疗程的强化诱导化疗（硫鸟嘌呤、标准剂量阿糖胞苷和柔红霉素，然后是高剂量阿糖胞苷和米托蒽醌;或在第一次和第二次诱导疗程中使用高剂量阿糖胞苷和米托蒽醌）。风险预测在801例患者的独立队列中得到验证结果体温、年龄、新发白血病与继发于细胞毒性治疗或既往血液病的白血病、血红蛋白、血小板计数、纤维蛋白原、血清乳酸脱氢酶浓度与CR或ED显著相关。了解细胞遗传学和分子学风险（评分1）的CR概率为12%~ 91%，不了解（评分2）的CR概率为21%~ 80%。评分1时预测艾德的风险为6%-69%，评分2时为7%-63%。风险评分的预测能力在独立的患者队列中得到证实（CR评分1，10%~ 91%，CR评分2，16%~ 80%，艾德评分1，6%~ 69%，和艾德评分2，7%至61%）.解释急性髓性白血病的评分可用于预测老年急性髓性白血病患者CR的概率和艾德的风险，但在其他方面健康，计划对他们进行强化诱导化疗。这些信息可以帮助医生做出治疗这些患者的困难决定。
Background About 50% of patients (age >= 60 years) who have acute myeloid leukaemia and are otherwise medically healthy (ie, able to undergo intensive chemotherapy) achieve a complete remission (CR) after intensive chemotherapy, but with a substantially increased risk of early death (ED) compared with younger patients. We verified the association of standard clinical and laboratory variables with CR and ED and developed a web-based application for risk assessment of intensive chemotherapy in these patients.Methods Multivariate regression analysis was used to develop risk scores with or without knowledge of the cytogenetic and molecular risk profiles for a cohort of 1406 patients (aged >= 60 years) with acute myeloid leukaemia, but otherwise medically healthy, who were treated with two courses of intensive induction chemotherapy (tioguanine, standard-dose cytarabine, and daunorubicin followed by high-dose cytarabine and mitoxantrone; or with high-dose cytarabine and mitoxantrone in the first and second induction courses) in the German Acute Myeloid Leukaemia Cooperative Group 1999 study. Risk prediction was validated in an independent cohort of 801 patients (aged >60 years) with acute myeloid leukaemia who were given two courses of cytarabine and daunorubicin in the Acute Myeloid Leukaemia 1996 study.Findings Body temperature, age, de-novo leukaemia versus leukaemia secondary to cytotoxic treatment or an antecedent haematological disease, haemoglobin, platelet count, fibrinogen, and serum concentration of lactate dehydrogenase were significantly associated with CR or ED. The probability of CR with knowledge of cytogenetic and molecular risk (score 1) was from 12% to 91%, and without knowledge (score 2) 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. The predictive power of the risk scores was confirmed in the independent patient cohort (CR score 1, from 10% to 91%; CR score 2, from 16% to 80%; ED score 1, from 6% to 69%; and ED score 2, from 7% to 61%).Interpretation The scores for acute myeloid leukaemia can be used to predict the probability of CR and the risk of ED in older patients with acute myeloid leukaemia, but otherwise medically healthy, for whom intensive induction chemotherapy is planned. This information can help physicians with difficult decisions for treatment of these patients.