Artículo de revista
Pre-Treatment Risk Assessment for Elderly Patients with Acute Myeloid Leukemia
Fecha
2018-09Autor
Arévalo Zambrano, Mónica
Abello Polo, Virginia
Omaña Orduz, Olga Paola
Villamizar Gómez, Liceth
Resumen
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 Bogotá. 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 Bogotá, 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.