Elderly patients with acute myeloid leukemia (AML) have a very poor prognosis, explained by the biologic characteristics of the disease but also by host-related factors including comorbidities. The objective of this study was to determine the prognostic role of comorbidities in this population. Between 1995 and 2004, 133 patients aged 70 years or older with newly diagnosed acute non promyelocytic leukemia, were treated with intensive induction chemotherapy (“3+7” regimen) at a single institution. Comorbidities at diagnosis were retrospectively evaluated using an adapted form of the Charlson Comorbidity index (CCI) (

Sorror et al.,
Blood
2004
;
104
:
961
–968
). Seventy-five patients achieved a complete response (CR) (56.4%) and 23 patients died during induction chemotherapy (17.3%). Comorbidity scores at diagnosis were 0 for 83 patients (68%), 1 for 16 patients (13.1%), and > 1 for 23 patients (18.7%). The median overall survival (OS) was 9 months (95% CI: 6–13) and was significantly poorly affected by high leukocyte count (≥ 30 G/l) and elevated serum creatinine level (>1.5 x upper normal limit). By multivariate analysis, we identified 4 adverse prongnostic factors for CR: unfavorable karyotype, leukocytosis ≥ 30 G/l, expression of CD34 on blast cells and a CCI > 1. Age was not found to be a significant prognosic factor for either CR or survival. When a score of 0 or 1 was affected to each prognostic variable, patients could be separated into a low-risk group (score= 0–1; 22% of patients), an intermediate-risk group (score= 2; 41% of patients) and a high-risk group (score≥3 ; 37% of patients), having 87%, 63% and 37% chance of achieving CR following conventional induction chemotherapy, an 8-week mortality rate of 9%, 22% and 34% (p=0.02), and a 2-year overall survival rate above 50%, less than 30% and 15%, respectively (p=0.01).

Our results show that comorbidity is an important prognostic factor for elderly patients with AML which may help the physicians’ decision making. Its capture at diagnosis should be prospectively evaluated in larger study for its future use for risk-stratification among elderly patients treated for AML.

Topics:
comorbidity, leukemia, myelocytic, acute, older adult, chemotherapy, neoadjuvant, acute promyelocytic leukemia, cd34 antigens, complete remission, karyotype determination procedure, leukocytosis, prognostic factors

Disclosure: No relevant conflicts of interest to declare.

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2006, The American Society of Hematology
2006
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