Risk factors and decision criteria for intensive chemotherapy in older patients with acute myeloid leukemia
Risk factors and decision criteria for intensive chemotherapy in older patients with acute myeloid leukemia
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DOI：
10.3324/haematol.13309
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发表时间：
2008-12-01
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影响因子：
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通讯作者：
Dombret, Herve
中科院分区：
文献类型：
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作者：
Malfuson, Jean-Valere;Etienne, Anne;Dombret, Herve
背景老年急性髓系白血病患者的治疗决策需要标准化。本研究的目的是分析 ALFA-9803 试验中治疗的 416 名老年患者的不良危险因素的决策价值，以得出决策指数。设计和方法使用标准多变量分析来确定总体生存的危险因素。如果风险因素与频率 >10% 和假阳性率 = 75 年、体能状态 >= 2 以及白细胞计数 >= 50 x 10(9)/L 相关，则被认为是良好的决策工具。这个简单的两类决策指标在独立的患者组中得到了验证，使我们能够区分 100 名患者 (24%)，这些患者在 12 个月时估计总生存率仅为 19%，假阳性率高达 9%。结论我们建议在老年急性髓系白血病患者做出治疗决策之前等待细胞遗传学信息。细胞遗传学不良的患者，以及至少具有以下特征中的两种的患者：年龄>= 75岁，体能状态>= 2，白细胞计数>= 50 x 10(9)/L，不应考虑接受标准强化化疗（ClinicalTrials.gov标识符：NCT00363025）。
BackgroundThere is a need for standardization of treatment decisions in older patients with acute myeloid leukemia. The aim of the present study was to analyze the decisional value of poor risk factors in 416 elderly patients treated in the ALFA-9803 trial in order to derive a decisional index.Design and MethodsStandard multivariate analysis was used to identify risk factors for overall survival. Risk factors were then considered as good decision tools if associated with a frequency >10% and a false positive rate = 75 years, performance status >= 2, and white cell count >= 50 x 10(9)/L. This simple two-class decisional index, which was validated in an independent patient set, enabled us to discriminate 100 patients (24%) who had an estimated overall survival of only 19% at 12 months, with a good 9% false positive rate.ConclusionsWe propose waiting for cytogenetic information before making treatment decisions in elderly patients with acute myeloid leukemia. Those patients with unfavorable cytogenetics, as well as patients with at least two of the following features, age >= 75 years, performance status >= 2, and white cell count >= 50 x 10(9)/L, should not be considered for standard intensive chemotherapy (ClinicalTrials.gov identifier: NCT00363025).