The first 2 authors contributed equally to this article.
Article first published online: 29 JUN 2011
Copyright © 2011 American Cancer Society
Volume 118, Issue 2, pages 410–417, 15 January 2012
How to Cite
Valcárcel, D., Montesinos, P., Sánchez-Ortega, I., Brunet, S., Esteve, J., Martínez-Cuadrón, D., Ribera, J. M., Tormo, M., Bueno, J., Duarte, R., Llorente, A., Torres, J. P., Guardia, R., Sanz, M. A., Sierra, a. J. and on behalf of the CETLAM Group (2012), 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. Cancer, 118: 410–417. doi: 10.1002/cncr.26273
David Valcárcel and Pau Montesinos conceived the study, analyzed, and interpreted the data; David Valcárcel and Pau Montesinos wrote the paper; David Valcárcel and Pau Montesinos performed the statistical analyses; Isabel Sánchez-Ortega, Salut Brunet, Jordi Esteve, David Martínez-Cuadrón, José M. Ribera, Mar Tormo, Javier Bueno, Rafael Duarte, Andrés Llorente, P. Torres, Ramón Guardia, Miguel A Sanz, and Jorge Sierra included data of patients treated in their institutions, reviewed the manuscript, and contributed to the final draft.
We thank the physicians and centers participating in the study: J. Esteve, Clinical Hospital (Hospital Clínic), Barcelona, Spain; S. Brunet, Santa Creu i Sant Pau Hospital (Hospital de la Santa Creu i Sant Pau) , Barcelona, Spain; J. Berlanga, Catalan Institute of Oncology (Institut Català d' Oncologia), Hospitalet de Llobregat, Spain; J. M. Ribera, Germans Trias i Pujol Hospital (Hospital Germans Trias i Pujol), Badalona, Spain; M. Tormo, University Clinical Hospital (Hospital Clínic Univeristari), Valencia, Spain; J. Bueno, Vall d' Hebrón Hospital (Hospital de la Vall d' Hebrón), Barcelona, Spain; A. Llorente, Joan XXIII Hospital (Hospital Joan XXIII), Tarragona, Spain; M. Queipo de Llano, Clinical Hospital of Málaga (Hospital Clínico de Málaga), Spain; J. Besalduch, Son Dureta Hospital (Hospital Son Dureta), Palma de Mallorca, Spain; C. Pedro, del Mar Hospital (Hospital del Mar), Barcelona, Spain; J. M. Sánchez Villegas, Arnau de Vilanova Hospital (Hospital Arnau de Vilanova), Lleida, Spain; J. M. Moraleda, Virgen de la Arrixaca Hospital (Hospital Virgen de la Arrixaca), Murcia, Spain; J. M. Martí, Mutua Hospital (Hospital Mutua), Tarrasa, Spain; Ll. Font, Verge de la Cinta Hospital (Hospital Verge de la Cinta), Tortosa, Spain; J. Bargay, Son Llatzer Hospital (Hospital Son Llatzer), Palma de Mallorca, Spain; P. Vivancos, Teknon Clinic (Clínica Teknon), Barcelona, Spain; D. Hernández, La Paz Hospital (Hospital La Paz), Madrid, Spain; and Guillermo Martín, Jesús Martínez, Ignacio Lorenzo, and Javier Palau, University Hospital La Fe (Hospital Universitario La Fe), Valencia, Spain.
- Issue published online: 5 JAN 2012
- Article first published online: 29 JUN 2011
- Manuscript Accepted: 8 APR 2011
- Manuscript Revised: 17 MAR 2011
- Manuscript Received: 17 JAN 2011
- acute myeloid leukemia;
- induction death;
- scoring system
A prognostic index to predict induction death in adult patients receiving induction chemotherapy for de novo acute myeloid leukemia (AML) was developed.
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.
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 × 109/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).
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. Cancer 2011;. © 2011 American Cancer Society.