Introduction:
Acute myeloid leukemia (AML) is an aggressive hematologic malignancy that has a poor prognosis. Not only does AML lead to mortality, but toxicity from chemotherapy can result in life-threatening complications. While the goal of treatment for some AML patients is cure, if the risks of chemotherapy are substantial, then less aggressive treatment regimens, including no treatment, should be pursued. The goal of this study was to identify risk factors for early mortality among patients with AML who receive chemotherapy.
Methods:
This study was a retrospective chart review. From January 2015 to August 2019, patients who received chemotherapy for AML were included. Demographic and clinical characteristics were gathered from when the patient was first suspected to have AML: age, sex, race, body surface area (BSA), white blood cell count (WBC), hemoglobin, platelet count, lactate dehydrogenase (LDH), and uric acid. The outcome was weeks of survival from the first day of treatment. The independent samples Mann-Whitney Test was used for dichotomous comparisons.
Results:
Forty-nine patients were included in the study. Patients aged ≤65 years old had greater median survival than those >65 years old (40.36 weeks vs. 11.50 weeks, p=0.045). Patients with a hemoglobin >8 g/dL had greater median survival than those ≤8g/dL (45.43 weeks vs. 6.57 weeks, p<0.001). Patients with a platelet count >50,000/mm3 had greater median survival than those ≤50,000/mm3 (47.72 weeks vs. 8.29 weeks, p<0.001). Sex and race were not related to survival time nor were cutoffs for BSA, WBC, LDH, and uric acid.
For the 23 of 49 patients who survived less than six months from the time they started chemotherapy, patients with a platelet count >50,000/mm3 had greater median survival than those ≤50,000/mm3 (11.29 weeks vs. 4.43 weeks, p=0.016). Also, for patients surviving less than six months, those with BSA >1.95 m2 had median survival of 10 weeks versus median survival of 4.5 weeks for BSA ≤1.95 m2 (p=0.07).
Conclusion:
For patients receiving chemotherapy for AML, we found that in addition to older age, lower hemoglobin and lower platelet count were risk factors for survival time and should be considered before embarking on an aggressive treatment regimen, as the risks may outweigh the benefits.
No relevant conflicts of interest to declare.
