Prognostic index for adult patients with acute myeloid leukemia in first relapse.
OBJECTIVE
The treatment of acute myeloid leukemia (AML) in first relapse is associated with unsatisfactory rates of complete responses that usually are short lived. Therefore, a clinically useful prognostic index can facilitate therapeutic decision making and evaluation of investigational treatment strategies at relapse of AML.


METHODS
A prognostic score is presented based on the multivariate analysis of 667 AML patients in first relapse among 1,540 newly diagnosed non-M3 AML patients (age 15 to 60 years) entered onto three successive Dutch-Belgian Hemato-Oncology Cooperative Group and the Swiss Group for Clinical Cancer Research Collaborative Group trials.


RESULTS
Four clinically relevant parameters are included in this index (ie, length of relapse-free interval after first complete remission, cytogenetics at diagnosis, age at relapse, and whether previous stem-cell transplantation was performed). Using this stratification system, three risk groups were defined: a favorable prognostic group A (overall survival [OS] of 70% at 1 year and 46% at 5 years), an intermediate-risk group B (OS of 49% at 1 year and 18% at 5 years), and a poor-risk group C (OS of 16% at 1 year and 4% at 5 years).


CONCLUSIONS
The prognostic index estimates the outcome of AML patients in first relapse using four commonly applied clinical parameters and might identify patients who are candidates for salvage and investigational therapy.
Breems
Dimitri A
DA
Erasmus University Medical Center, Department of Hematology, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
Van Putten
Wim L J
WL
Huijgens
Peter C
PC
Ossenkoppele
Gert J
GJ
Verhoef
Gregor E G
GE
Verdonck
Leo F
LF
Vellenga
Edo
E
De Greef
Georgine E
GE
Jacky
Emanuel
E
Van der Lelie
Johannes
J
Boogaerts
Marc A
MA
Löwenberg
Bob
B
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use; D006801:Humans; D007951:Leukemia, Myeloid / Q000235:genetics / Q000401:mortality* / Q000628:therapy; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D012008:Recurrence; D016879:Salvage Therapy / Q000379:methods; D016019:Survival Analysis
D000970:Antineoplastic Agents