A new study proposes a survival model based on 11 “consistent independent adverse factors” associated with survival outcomes in patients with newly diagnosed acute myeloid leukemia (AML) who are older or considered “unfit” and received lower-intensity chemotherapy.
Koji Sasaki, MD, of the MD Anderson Cancer Center, and colleagues, conducted the study to develop a prognostic model for survival in this group of patients.
Dr. Sasaki and colleagues reviewed data from all patients with newly diagnosed AML who were older or considered “unfit” and received lower-intensity chemotherapy between 2000 and 2020 at a single institution. The study included 1,462 patients, with 1,088 patients serving as a training group, and the remaining 374 patients serving as a validation group. The median patient age was 72 years.
In the training cohort, a multivariate analysis identified 11 “consistent independent adverse factors associated with survival,” Dr. Sasaki and colleagues wrote.
Those factors include the following:
- older age
- having a therapy-related myeloid neoplasm
- existence of previous myelodysplastic syndromes or myeloproliferative neoplasms
- poor performance status
- pulmonary comorbidity
- elevated lactate dehydrogenase
- cytogenetic abnormalities
- the presence of infection at diagnosis
- receiving a therapy not containing venetoclax
The three-year survival rate was 52% in patients who were deemed “favorable” risk, while the three-year survival rate was 24% for patients with intermediate risk, 10% for those with poor risk, and 1% for those with very poor risk.
The researchers also identified IDH2 and NPM1 mutations as “favorable” molecular prognostic features, and TP53 mutations as “unfavorable” molecular prognostic factors after accounting for the effects of previous factors.
Dr. Sasaki and colleagues validated the survival model in an independent cohort and believe it could help direct treatment and research strategies.
“The proposed survival model with lower-intensity chemotherapy in older/unfit patients with newly diagnosed AML may help to advise patients on their expected outcome, to propose different strategies in first complete remission, and to compare the results of different existing or future investigational therapies,” Dr. Sasaki and colleagues concluded.
Sasaki K, Ravandi F, Kadia TM, et al. Prediction of survival with lower intensity therapy among older patients with acute myeloid leukemia. Cancer. 2023. doi:10.1002/cncr.34609