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999 The Prognostic Validity of the Acute Myeloid Leukemia Composite Model in Predicting Risks of One-Year Mortality Among Patients in Atlantic Canada: A Multi-Centre Experience

Program: Oral and Poster Abstracts
Session: 613. Acute Myeloid Leukemia: Clinical Studies: Poster I
Hematology Disease Topics & Pathways:
AML, Adult, Diseases, Study Population, Myeloid Malignancies, Clinically relevant
Saturday, December 5, 2020, 7:00 AM-3:30 PM

Shannon Murphy, MD, MBA1, Brian Harnett, MD2*, Kara Matheson3*, David M. Jones, MD4*, Abdulrahim Basendwah, MD5, Sudeep P Shivakumar, MD, BSc6* and Mahmoud Elsawy, MB6*

1Dalhousie University, Halifax, NS, Canada
2Memorial University of Newfoundland, St. John's, Canada
3Research Methods Unit, Nova Scotia Health Authority, Centre for Clinical Research, NS health, halifax, Canada
4Memorial University, St John's, NL, CAN
5King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
6Division of Hematology, Dalhousie University, Halifax, NS, Canada

Introduction: Intensive chemotherapy is the standard of care for remission induction for fit patients with newly diagnosed acute myeloid leukemia (AML). However, assessing the prognostic impact of comorbidities on outcomes when counselling patients remains a challenge. To this end, we sought to validate the prognostic validity of a newly proposed AML composite model (AML-CM) which incorporates both comorbidities and leukemia-specific features to predict overall mortality following administration of intensive induction chemotherapy.

Methods: We retrospectively collected data on patients with newly diagnosed AML who received their first induction chemotherapy in Halifax, NS and St. John’s, NL, Canada. The AML-CM scores were calculated as per previously published guidelines (Sorror et al in 2017). Logistic regression models were performed to analyze 8-week and 1-year mortality and competing risk regression with Fine and Grey model to model overall survival after adjusting for known variables.

Results: 194 patients treated January 1, 2009 to December 31, 2017 were identified. Fifty-six percent were males. Median age at induction was 54 years with an age range from 18 to 75 years. Thirty-eight percent of patients were 60 years or older. Molecular/cytogenetic risk per ELN classification was as follows: 23% favourable risk, 37% intermediate risk, 34% high risk, and 6% unknown. The most frequently used regimen was the standard 3+7 regimen (daunorubicin and cytarabine). The AML-CM was predictive of 8-week mortality, odds ratio 12 (95%CI 3.15-45.75) AML-CM 10+ vs AML-CM 1-4, (p-value 0.0003) and 1-year mortality, odds ratio 11.76 (95% CI 2.45-56.51) AML-CM 10+ vs AML-CM 1-4 (p-value 0.0021). Overall survival was inversely proportional to increasing AML-CM scores (p <0.001). Overall survival at 1 year for patients with AML-CM scores 1-4, 5-6, 7-9, ≥10 was 50%, 30% 18%, and 2%, respectively (p-value 0.002) (Figure 1).

Conclusions: The AML-CM is a valid prognosticator for early and late mortality in our patient population. Our findings emphasize the significance of comorbidities assessment prior to induction therapy for AML and the potential use in tailoring targeted interventions to mitigate their risks alongside leukemia treatments. Additionally, the AML-CM could be utilized to adjust for the impact of comorbidities in clinical trials investigating newer intensive AML therapies.

Figure 1: Overall survival by AML-CM score range

Disclosures: No relevant conflicts of interest to declare.

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