A dynamic 3‐factor survival model for acute myeloid leukemia that accounts for response to induction chemotherapy

摘要

Abstract The current study was approached with the assumption that response to induction chemotherapy, in acute myeloid leukemia (AML), overshadows pre‐treatment risk variables in predicting survival and therefore be used as an anchor for a simplified risk model. We considered 759 intensively‐treated patients with AML, not promyelocytic: median age 60?years; primary 66, secondary 25, and therapy‐related 9; European LeukemiaNet cytogenetic risk category favorable 8, intermediate 61, and adverse 31. Complete remission with (CR) or without (CRi) count recovery was achieved in 608 (80) patients. After a median follow‐up of 22?months, 503 deaths, 272 relapses, and 257 allogeneic hematopoietic stem cell transplants (AHSCTs) were recorded. Multivariable analysis identified failure to achieve CR/CRi (HR 3.8, 95 CI 3.1–4.8), adverse karyotype (2.2, 1.8–2.8), and age >55?years (2.1, 1.6–2.7) as main risk factors for survival. HR‐weighted scoring resulted in four‐tiered risk stratification: low (0 points; N?=?183), intermediate‐1 (1 point; N?=?331), intermediate‐2 (2 points; N?=?117), and high (≥3 points; N?=?128), with respective median survival (5‐year rate) not reached (68), 34 (37), 13 (20), and 5 (5) months (p?