Pre-Treatment Risk Assessment for Elderly Patients with Acute Myeloid Leukemia
Artículo de revista
Clinical lymphoma, myeloma and leukemia
The treatment of AML in older adults is limited by the high mortality related with induction chemotherapy; however, those who tolerate an intensive treatment will have better outcomes; therefore, selecting this group of patients through the use of functionality scales is a fundamental part of the initial therapeutic approach. Risk assessment scales have been designed and validated by other authors; in our country they have not been routinely used until now. Objective: To describe 8-week treatment related and 1- year mortality in AML patients, older than 60 years, after selecting treatment based on functionality risk scores (FRS), at two hospitals in Bogotá. Design: An observational study was performed, analyzing early mortality in two cohorts; a retrospective, including patients treated from 2010-2015 and a prospective one, from 2015 to 2018, in which the treatment was selected according FRS (SPPB, CCI and MD Anderson Predictive Score). Setting: Patients were treated in two university hospitals in Bogotá, Colombia. Patients: AML patients older than 60 years; acute promyelocytic leukemia patients were excluded. Interventions: FRS were assessed at diagnosis, high risk patients received supportive care, intermediate risk received 5-Azacitidine or low dose ARA-C, low risk patient wereconsidered eligible for standard induction chemotherapy (7+3). Main Outcomes Measures: We evaluated 8-week mortality as predicted by a combination of 3 different scales and compared it with a control retrospective cohort. Results: Sixty patients were included, median age 72 years (range: 62 - 84), 78% had intermediate cytogenetic risk and 20% high risk. 35% had a history of another hematological neoplasm. Only 38.3% received high intensity chemotherapy. Survival at 8 weeks was 70% without differences between treatment groups. One-year mortality was high, 73.9% of patients treated with 7x3 died, 80% in the low intensity group and 85.7% in the best support treatment. The ICC scale was predictive of 1-year mortality, but not the MD Anderson scale. Conclusions: In this high-risk group, 7+3 was well tolerated when patients were selected using FRS. The CCI scale was predictive of one-year mortality and could be used to optimize the selection of elderly patients with AML.
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