Prognostic factors in elderly patients with acute myeloid leukemia

Abstract

Introduction: Acute myeloid leukemia (AML) is characterized by pathological proliferation of myeloid lineages. It predominantly occurs in patients over 60 years of age, whose outcome is considerably worse, as compared to younger patients. Aim: The aim of the study was the analysis of the clinical characteristics of older patients with AML and their impact on the following: achieving complete remission (CR), overall survival (OS), early mortality (EM), and relapse. Materials and methods: This retrospective study included 94 patients with AML, treated with chemotherapy and palliative treatment, whose information was taken from their medical histories, upon treatment. The following clinical features were analyzed as risk factors for OS, CR, relapse and EM: leukocytes, the level of serum lactate dehydrogenase (LDH), performance status on the ECOG (Eastern Cooperative Oncology Group) scale, the European LeukemiaNet cytoplasmic risk group, the HCT-CI (hematopoietic cell transplantation - comorbidity index) and the NPM1/ FLT3-ITD (nucleophosmin 1/FLT3-internal tandem mutation) molecular status. For the identification of prognostic factors, the Cox regression analysis was used. Results: The average age of the patients was 69 years (range: 65 - 87). CR was achieved in 23 (46%) of the 50 patients (53.2%) who received intensive chemotherapy, with relapse occurring in 17/23 patients (73.9%). EM was reported in 17 patients (18.1%). Patients with ECOG PS > 2 had a statistically significantly lower OS than patients with ECOG PS < 2 (p = 0.030). Patients with HCT-CI > 3 had a poorer OS than patients with HCT-CI < 3 (p = 0.040). Serum LDH > 450 U/I was found to be a factor, i.e., marker of unfavorable prognosis for the OS, as compared to LDH < 450U/I (p = 0.044). Conclusion: The conclusion is that older AML patients with poorer ECOG PS, high HCT-CI, increased LDH levels have a poorer OS.