Treating octogenarian and nonagenarian acute myeloid leukemia patients—Predictive prognostic models


  • All authors reviewed and approved the final article. Dr. Harb reviewed all cases and wrote the article. Ms. Tan and Dr. Wilding performed the statistical analyses. Ms. Ford constructed the database. Drs. Sait and Block reviewed all karyotype analyses. Dr. Barcos reviewed the pathology specimens. Dr. Wallace reviewed the flow cytometry data. Dr. Wang contributed to the care of the patients. Dr. Wetzler oversaw the conduct of the study and contributed to article preparation.



Treating the octogenarian and nonagenarian patients who have acute myeloid leukemia (AML) with intensive chemotherapy is controversial. Several models to predict outcome were proposed, including the use of a comorbidity index. However, it is unclear whether the Charlson comorbidity index (CCI) or the hematopoietic cell transplant comorbidity index (HCTCI) is more sensitive.


The authors analyzed their experience with 92 patients aged ≥80 years who had AML. Patients' pretreatment characteristics and their treatment outcomes were recorded.


All patients were offered intensive treatment; 59 patients (64%) were treated intensively with a variety of regimens, whereas 33 patients (36%) elected to receive supportive care. The CCI and the HCTCI had similar predictive ability for outcome in both groups. A multivariate analyses of prognostic factors identified near-normal albumin (48% of patients; 1-year survival rate, >27%) as a favorable factor for the whole cohort, age <83 years (47% of patients; 1-year survival rate, >25%) and nonmonocytic morphology (75% of patients; 1-year survival rate, >26%) as favorable factors for the intensively treated cohort, and bone marrow blasts <46% (50% of patients; 1-year survival rate, >19%) as a favorable factor for patients who received supportive care.


This retrospective analysis was developed to assist in treatment decisions for octogenarian and nonagenarian patients with AML. The findings will need validation in a prospective study. Cancer 2009. © 2009 American Cancer Society.