title: A novel prognostic model in elderly patients with acute myeloid leukemia: results of 909 patients entered into the prospective AML96 trial.
abstract: We present an analysis of prognostic factors derived from a trial in patients with acute myeloid leukemia older than 60 years. The AML96 trial included 909 patients with a median age of 67 years (range, 61-87 years). Treatment included cytarabine-based induction therapy followed by 1 consolidation. The median follow-up time for all patients is 68 months (5.7 years). A total of 454 of all 909 patients reached a complete remission (50%). Five-year overall survival (OS) and disease-free survival were 9.7% and 14%, respectively. Multivariate analyses revealed that karyotype, age, NPM1 mutation status, white blood cell count, lactate dehydrogenase, and CD34 expression were of independent prognostic significance for OS. On the basis of the multivariate Cox model, an additive risk score was developed that allowed the subdivision of the largest group of patients with an intermediate-risk karyotype into 2 groups. We are, therefore, able to distinguish 4 prognostic groups: favorable risk, good intermediate risk, adverse intermediate risk, and high risk. The corresponding 3-year OS rates were 39.5%, 30%, 10.6%, and 3.3%, respectively. The risk model allows further stratification of patients with intermediate-risk karyotype into 2 prognostic groups with implications for the therapeutic strategy.
authors.affiliation: Medizinische Klinik und Poliklinik I, Universitätsklinikum Dresden, Fetscherstrasse 74, Dresden, Germany. christoph.roellig@uniklinikumdresden.de
authors.forename: Christoph
authors.initials: C
authors.lastname: Röllig
authors.forename: Christian
authors.initials: C
authors.lastname: Thiede
authors.forename: Martin
authors.initials: M
authors.lastname: Gramatzki
authors.forename: Walter
authors.initials: W
authors.lastname: Aulitzky
authors.forename: Heinrich
authors.initials: H
authors.lastname: Bodenstein
authors.forename: Martin
authors.initials: M
authors.lastname: Bornhäuser
authors.forename: Uwe
authors.initials: U
authors.lastname: Platzbecker
authors.forename: Reingard
authors.initials: R
authors.lastname: Stuhlmann
authors.forename: Ulrich
authors.initials: U
authors.lastname: Schuler
authors.forename: Silke
authors.initials: S
authors.lastname: Soucek
authors.forename: Michael
authors.initials: M
authors.lastname: Kramer
authors.forename: Brigitte
authors.initials: B
authors.lastname: Mohr
authors.forename: Uta
authors.initials: U
authors.lastname: Oelschlaegel
authors.forename: Friedrich
authors.initials: F
authors.lastname: Stölzel
authors.forename: Malte
authors.initials: M
authors.lastname: von Bonin
authors.forename: Martin
authors.initials: M
authors.lastname: Wermke
authors.forename: Hannes
authors.initials: H
authors.lastname: Wandt
authors.forename: Gerhard
authors.initials: G
authors.lastname: Ehninger
authors.forename: Markus
authors.initials: M
authors.lastname: Schaich
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D015331:Cohort Studies; D003561:Cytarabine / Q000627:therapeutic use; D003630:Daunorubicin / Q000627:therapeutic use; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy* / Q000235:genetics / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009687:Nuclear Proteins / Q000235:genetics; D000090243:Nucleophosmin; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012074:Remission Induction; D012307:Risk Factors; D051941:fms-Like Tyrosine Kinase 3 / Q000235:genetics
chemical_list: D000964:Antimetabolites, Antineoplastic; C000716967:NPM1 protein, human; D009687:Nuclear Proteins; D003561:Cytarabine; D000090243:Nucleophosmin; C497970:FLT3 protein, human; D051941:fms-Like Tyrosine Kinase 3; D003630:Daunorubicin