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Koji Sasaki Tapan Kadia Kebede Begna Courtney D. DiNardo Gautam Borthakur Nicholas J. Short Nitin Jain Naval Daver Elias Jabbour Guillermo Garcia-Manero Guillermo Montalban Bravo Lucia Masarova Sherry Pierce Marina Konopleva Farhad Ravandi Ayalew Tefferi Hagop Kantarjian 《American journal of hematology》2022,97(1):68-78
The progress with intensive chemotherapy and supportive care measures has improved survival in patients with newly diagnosed acute myeloid leukemia (AML). Given the recent development of effective low intensity therapies, an optimal decision on the therapy intensity may improve survival through the avoidance of early mortality. We reviewed the outcome of 3728 patients with newly diagnosed AML who received intensive chemotherapy between August 1980 and May 2020. Intensive chemotherapy was defined as a cumulative cytarabine dose ≥ 700 mg/m2 during induction therapy. We divided the whole cohort into a training and validation group at a 3:1 ratio. The population was divided into a training (2790 patients) and a validation cohort (938 patients). The median age was 55 years (range, 15-99). Among them, 442 patients (12%) had core-binding factor AML. Binary logistic regression identified older age, worse performance status, hyperbilirubinemia, elevated creatinine, hyperuricemia, cytogenetic abnormalities other than CBF and -Y, and pneumonia as adverse prognostic factors for an early 4-week mortality. This risk classification for early mortality was verified in the validation cohort of patients. In the validation cohort of more recently treated patients from 2000 to 2017, the 4-week mortality rates with intensive chemotherapy were 2%, 14%, and 50% in the low-, high-, and very high-risk group, respectively. The mortality rates with low intensity therapies were 3%, 9%, and 20%, respectively. The risk classification guides treatment intensity by the assessment of age, frailty, organ dysfunction, cytogenetic abnormality, and infection to avoid early mortality. 相似文献
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Patrick Demkowicz BS Renelle Pointdujour-Lim MD Sofia Miguez BA Yesung Lee BS Bailey S. C. L. Jones BS Christopher A. Barker MD Marcus Bosenberg MD PhD David H. Abramson MD Alexander N. Shoushtari MD Harriet Kluger MD Jasmine H. Francis MD Mario Sznol MD Mathieu F. Bakhoum MD PhD 《Cancer》2023,129(20):3275-3286
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