title: Comorbidity and performance status in acute myeloid leukemia patients: a nation-wide population-based cohort study.
abstract: As the world population ages, the comorbidity burden in acute myeloid leukemia (AML) patients increases. Evidence on how to integrate comorbidity measures into clinical decision-making is sparse. We determined the prognostic impact of comorbidity and World Health Organization Performance Status (PS) on achievement of complete remission and mortality in all Danish AML patients treated between 2000 and 2012 overall and stratified by age. Comorbidity was measured using a modified version of the Charlson Comorbidity Index, with separate adjustment for pre-leukemic conditions. Of 2792 patients, 1467 (52.5%) were allocated to intensive therapy. Of these patients, 76% did not have any comorbidities, 19% had one comorbid disease and 6% had two or more comorbidities. Low complete remission rates were associated with poor PS but not with comorbidity. Surprisingly, among all intensive therapy patients, presence of comorbidity was not associated with an increased short-term mortality (adjusted 90 day mortality rate (MR)=1.06 (95% confidence interval (CI)=0.76-1.48)) and, if any, only a slight increase in long-term mortality (91 day-3 year adjusted MR=1.18 (95%CI=0.97-1.44). Poor PS was strongly associated with an increased short- and long-term mortality (adjusted 90 day MR, PS⩾2=3.43 (95%CI=2.30-5.13); adjusted 91 day-3 year MR=1.35 (95%CI=1.06-1.74)). We propose that more patients with comorbidity may benefit from intensive chemotherapy.
authors.affiliation: 1] Department of Hematology, Aarhus University Hospital, Aarhus, Denmark [2] Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: L S G
authors.initials: LS
authors.lastname: Østgård
authors.affiliation: Department of Hematology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: J M
authors.initials: JM
authors.lastname: Nørgaard
authors.affiliation: Department of Hematology, Rigshospitalet, Copenhagen, Denmark.
authors.forename: H
authors.initials: H
authors.lastname: Sengeløv
authors.affiliation: 1] Department of Hematology, Aalborg University Hospital, Aalborg, Denmark [2] Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
authors.forename: M
authors.initials: M
authors.lastname: Severinsen
authors.affiliation: Department of Hematology, Rigshospitalet, Copenhagen, Denmark.
authors.forename: L S
authors.initials: LS
authors.lastname: Friis
authors.affiliation: Department of Hematology, Odense University Hospital, Odense, Denmark.
authors.forename: C W
authors.initials: CW
authors.lastname: Marcher
authors.affiliation: Department of Hematology, Herlev University Hospital, Herlev, Denmark.
authors.forename: I H
authors.initials: IH
authors.lastname: Dufva
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: M
authors.initials: M
authors.lastname: Nørgaard
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology; D015331:Cohort Studies; D015897:Comorbidity; D003718:Denmark / Q000453:epidemiology; D005260:Female; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology; D008171:Lung Diseases / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012042:Registries; D012074:Remission Induction; D016019:Survival Analysis
chemical_list: D000970:Antineoplastic Agents
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