title: Treating octogenarian and nonagenarian acute myeloid leukemia patients--predictive prognostic models.
abstract: BACKGROUND
  Treating the octogenarian and nonagenarian patients who have acute myeloid leukemia (AML) with intensive chemotherapy is controversial. Several models to predict outcome were proposed, including the use of a comorbidity index. However, it is unclear whether the Charlson comorbidity index (CCI) or the hematopoietic cell transplant comorbidity index (HCTCI) is more sensitive.
  
  
  METHODS
  The authors analyzed their experience with 92 patients aged >or=80 years who had AML. Patients' pretreatment characteristics and their treatment outcomes were recorded.
  
  
  RESULTS
  All patients were offered intensive treatment; 59 patients (64%) were treated intensively with a variety of regimens, whereas 33 patients (36%) elected to receive supportive care. The CCI and the HCTCI had similar predictive ability for outcome in both groups. A multivariate analyses of prognostic factors identified near-normal albumin (48% of patients; 1-year survival rate, >27%) as a favorable factor for the whole cohort, age <83 years (47% of patients; 1-year survival rate, >25%) and nonmonocytic morphology (75% of patients; 1-year survival rate, >26%) as favorable factors for the intensively treated cohort, and bone marrow blasts <46% (50% of patients; 1-year survival rate, >19%) as a favorable factor for patients who received supportive care.
  
  
  CONCLUSIONS
  This retrospective analysis was developed to assist in treatment decisions for octogenarian and nonagenarian patients with AML. The findings will need validation in a prospective study.
authors.affiliation: Leukemia Section, Department of Medicine, Roswell Park Cancer Institute, Buffalo, New York 14263, USA.
authors.forename: Antoine J
authors.initials: AJ
authors.lastname: Harb
authors.forename: Wei
authors.initials: W
authors.lastname: Tan
authors.forename: Gregory E
authors.initials: GE
authors.lastname: Wilding
authors.forename: LaurieAnn
authors.initials: L
authors.lastname: Ford
authors.forename: Sheila N J
authors.initials: SN
authors.lastname: Sait
authors.forename: AnneMarie W
authors.initials: AW
authors.lastname: Block
authors.forename: Maurice
authors.initials: M
authors.lastname: Barcos
authors.forename: Paul K
authors.initials: PK
authors.lastname: Wallace
authors.forename: Eunice S
authors.initials: ES
authors.lastname: Wang
authors.forename: Meir
authors.initials: M
authors.lastname: Wetzler