The majority of patients diagnosed with AML who are 60 years of age or over are not offered specific anti-leukemia therapy. Outcomes in the minority who are offered standard induction are considerably inferior to those in younger patients. While a major factor is AML with inherently worse biology, comorbidity seen in the elderly which increases vulnerability to the adverse events of induction cytotoxic chemotherapy is also a major factor. The HCTCI is useful in predicting nonrelapse mortality and overall survival post stem cell transplantation (

Sorror. Blood. 2005;106:2912
) As this scale represents a refinement of the Charlson Comorbidity Index, and was developed specifically in patients with hematologic malignancies, we investigated whether it might also be applicable to elderly patients receiving AML induction chemotherapy. Pre-therapy comorbidity scoring by the HCTCI was assessed in a cohort of 177 patients over 60 years of age with AML treated at MDACC with standard idarubicin and ara-C induction since 1990. Median patient age was 70 (60–89), 64% were male, 26% had PS 2 or above, 60% had an antecedent hematological malignancy, and 90% had non favorable cytogenetics (33% -5/-7). 22% of patients had HCTCI scores of 0, 30% had scores of 1–2, and 48% scores of 3 or more. Complete response rates in the 3 groups were 64%, 43%, and 42% respectively (p=0.051). Early death (defined as death within 28 days from time of commencing induction therapy) was 3%, 11%, and 29% respectively (p= <0.001). HCTCI score was also highly correlated with EFS with a score of 0 associated with a median EFS of 26 weeks in contrast to a median EFS of 6 weeks in those with a HCTCI score greater than 0 (p=0.03). Even in the probably highly selected subset of patients over 60 years of age currently deemed suitable for standard induction therapy for AML, scoring of pre-treatment comorbidity using the HCTCI is predictable of early death rates and EFS. The further investigation of HCTCI scoring in AML induction, including its value relative to other standard prognostic indicators, is warranted. Stratification of patients for current therapy or for protocol entry based on HCTCI scores seems reasonable.

Topics:
cell transplantation, comorbidity, leukemia, myelocytic, acute, neoadjuvant therapy, hematologic neoplasms, adverse event, chemotherapy, neoadjuvant, complete remission, cytarabine, cytotoxic drug therapy

Disclosure: No relevant conflicts of interest to declare.

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2006, The American Society of Hematology
2006
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