title: A scoring system to predict the risk of death during induction with anthracycline plus cytarabine-based chemotherapy in patients with de novo acute myeloid leukemia.
abstract: BACKGROUND
  A prognostic index to predict induction death in adult patients receiving induction chemotherapy for de novo acute myeloid leukemia (AML) was developed.
  
  
  METHODS
  The authors analyzed 570 patients (aged 16-70 years) included in 2 multicenter trials of the CETLAM Group to develop a scoring system (study cohort). The scoring system was tested in 209 patients from an external single institution (validation cohort). Induction regimens consisted of anthracycline and cytarabine combination with or without etoposide. Induction death was defined as death in the first 42 days without evidence of leukemic resistance.
  
  
  RESULTS
  The cumulative incidence of induction death was 11% in the study cohort and 18% in the validation cohort. Median age was 48 years in the study cohort and 56 years in the validation cohort (P < .001). Multivariate analysis in the study cohort showed the following adverse risk factors for induction death: leukocyte count >100 × 10(9) /L, serum creatinine >1.2 mg/dL, and age ≥50 years. According to these factors, the authors developed a predictive score: low risk (no risk factors), intermediate risk (1 factor), and high risk (2 or 3 factors). The cumulative incidence of induction death in the 3 respective groups was 5%, 13%, and 26% (P < .001). The scoring system was applied in the validation cohort, resulting in cumulative incidence rates of induction death of 6%, 19%, and 32%, for the low-risk, intermediate-risk, and high-risk categories, respectively (P < .001).
  
  
  CONCLUSIONS
  By using this validated and simple scoring system, the risk of induction death in patients with AML can be predicted accurately. The score may be helpful to design risk-adapted induction strategies.
authors: Hematology Department, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain.
authors: David
authors: D
authors: Valcárcel
authors: Pau
authors: P
authors: Montesinos
authors: Isabel
authors: I
authors: Sánchez-Ortega
authors: Salut
authors: S
authors: Brunet
authors: Jordi
authors: J
authors: Esteve
authors: David
authors: D
authors: Martínez-Cuadrón
authors: José M
authors: JM
authors: Ribera
authors: Mar
authors: M
authors: Tormo
authors: Javier
authors: J
authors: Bueno
authors: Rafael
authors: R
authors: Duarte
authors: Andrés
authors: A
authors: Llorente
authors: Juan Pio
authors: JP
authors: Torres
authors: Ramón
authors: R
authors: Guardia
authors: Miguel A
authors: MA
authors: Sanz
authors: And Jorge
authors: AJ
authors: Sierra
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018943:Anthracyclines / Q000008:administration & dosage*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D003561:Cytarabine / Q000008:administration & dosage*; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D006801:Humans; D060828:Induction Chemotherapy / Q000401:mortality*; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors
chemical_list: D018943:Anthracyclines; D003561:Cytarabine; D005047:Etoposide