Risk Stratification in Older Intensively Treated Patients With AML.

Area of Science:

• Hematology
• Oncology
• Genetics

Background:

• Acute myeloid leukemia (AML) is genetically diverse, especially in patients over 60.
• Survival rates after intensive chemotherapy and allogeneic hematopoietic cell transplantation (allo-HCT) vary significantly in older AML patients.
• There is a critical need for a prognostic model to guide treatment decisions in this demographic.

Purpose of the Study:

• To develop and validate a prognostic model for older patients (≥60 years) with AML and high-risk myelodysplastic syndrome (HR-MDS).
• To identify patients who would benefit from intensive chemotherapy and allo-HCT.

Main Methods:

• Analysis of 1,910 intensively treated patients (≥60 years) with AML and HR-MDS from two cohorts.
• Utilized a random survival forest model incorporating clinical, molecular, and cytogenetic variables.
• Validated the model in independent AML and HR-MDS cohorts.

Main Results:

• The study cohort exhibited a high prevalence of adverse-risk features.
• A nine-variable model created four distinct prognostic groups (favorable, intermediate, poor, very poor) with significantly different 4-year overall survival (OS) rates across validation cohorts.
• The AML60+ classification demonstrated improved prognostic accuracy compared to existing models.
• Patients in the intermediate and very poor-risk groups significantly benefited from allo-HCT.

Conclusions:

• The novel AML60+ classification provides crucial prognostic information for older patients with AML and HR-MDS.
• This classification effectively identifies patients who are likely to benefit from intensive chemotherapy and allo-HCT.