2 research outputs found
Pre-Treatment Risk Assessment for Elderly Patients with Acute Myeloid Leukemia
The treatment of AML in older adults is limited by the
high mortality related with induction chemotherapy; however, those
who tolerate an intensive treatment will have better outcomes;
therefore, selecting this group of patients through the use of functionality scales is a fundamental part of the initial therapeutic
approach. Risk assessment scales have been designed and validated
by other authors; in our country they have not been routinely used
until now. Objective: To describe 8-week treatment related and 1-
year mortality in AML patients, older than 60 years, after selecting
treatment based on functionality risk scores (FRS), at two hospitals
in Bogot谩. Design: An observational study was performed,
analyzing early mortality in two cohorts; a retrospective, including
patients treated from 2010-2015 and a prospective one, from 2015
to 2018, in which the treatment was selected according FRS (SPPB,
CCI and MD Anderson Predictive Score). Setting: Patients were
treated in two university hospitals in Bogot谩, Colombia. Patients:
AML patients older than 60 years; acute promyelocytic leukemia
patients were excluded. Interventions: FRS were assessed at diagnosis, high risk patients received supportive care, intermediate risk
received 5-Azacitidine or low dose ARA-C, low risk patient wereconsidered eligible for standard induction chemotherapy (7+3).
Main Outcomes Measures: We evaluated 8-week mortality as
predicted by a combination of 3 different scales and compared it
with a control retrospective cohort. Results: Sixty patients were
included, median age 72 years (range: 62 - 84), 78% had intermediate cytogenetic risk and 20% high risk. 35% had a history of
another hematological neoplasm. Only 38.3% received high intensity chemotherapy. Survival at 8 weeks was 70% without differences between treatment groups. One-year mortality was high,
73.9% of patients treated with 7x3 died, 80% in the low intensity
group and 85.7% in the best support treatment. The ICC scale was
predictive of 1-year mortality, but not the MD Anderson scale.
Conclusions: In this high-risk group, 7+3 was well tolerated when
patients were selected using FRS. The CCI scale was predictive of
one-year mortality and could be used to optimize the selection of
elderly patients with AML