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Desprez C, Riou J, Peterlin P, Marchand T, Couturier MA, Villate A, Mear JB, Chevalier P, Guillerm G, Gyan E, Schmidt-Tanguy A, Walter RB, Hunault-Berger M, Orvain C. Comparison of scoring systems evaluating suitability for intensive chemotherapy in adults with acute myeloid leukemia-a Grand Ouest Against Leukemia (GOAL) study. Leukemia 2022; 36:2408-2417. [PMID: 35962057 DOI: 10.1038/s41375-022-01677-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/28/2022] [Accepted: 08/01/2022] [Indexed: 11/09/2022]
Abstract
Several scoring systems have been developed to assess suitability of individual patients for intensive acute myeloid leukemia (AML) therapy. We sought to compare the performance of these scores in a cohort of 428 consecutive adults with AML who received conventional induction chemotherapy in five academic centers in France. All scoring systems identified a subset of patients with increased 28 and 56-day mortality although the prediction accuracy was overall limited with C-statistics of ranging from 0.61 to 0.71 Overall survival (OS) prediction was more limited and restricted to scoring systems that include AML-related parameters. The outcome of 104 patients (24%) considered unsuitable for intensive chemotherapy based on criteria used in recent randomized trials was similar to that of the other 324 patients (28-day mortality, odds ratio [OR] = 1.88, P = 0.2; 56-day mortality, OR = 1.71, P = 0.21; event-free survival, hazard ratio [HR] = 1.08, P = 0.6; OS, HR = 1.25, P = 0.14) with low discrimination (C-statistic: 0.57, 0.56, 0.50, and 0.52 for 28-day, 56-day mortality, EFS, and OS, respectively). Together, our findings indicate that the accuracy of currently available approaches to identify patients at increased risk of early mortality and shortened survival after intensive AML therapy is relatively limited. Caution regarding the use of available scoring systems should be warranted in clinical decision-making.
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Affiliation(s)
| | - Jérémie Riou
- Univ Angers, CHU Angers, Inserm, CNRS, MINT, SFR ICAT, Angers, France
| | - Pierre Peterlin
- Service d'hématologie clinique, CHU de Nantes, Rennes, France.,Federation hospitalo-universitaire « Grand Ouest against Leukemia », Angers, France
| | - Tony Marchand
- Federation hospitalo-universitaire « Grand Ouest against Leukemia », Angers, France.,Service d'hématologie clinique, CHU de Rennes, Rennes, France.,INSERM U1236, Université Rennes 1, Rennes, France
| | - Marie-Anne Couturier
- Federation hospitalo-universitaire « Grand Ouest against Leukemia », Angers, France.,Service d'Hématologie Clinique, Hôpital Morvan, CHU de Brest, Rennes, France
| | - Alban Villate
- Federation hospitalo-universitaire « Grand Ouest against Leukemia », Angers, France.,Service d'Hématologie et Thérapie Cellulaire, Hôpital Bretonneau, CHRU de Tours, CNRS EMR7001 LNOx, Université de Tours, Rennes, France
| | - Jean-Baptiste Mear
- Federation hospitalo-universitaire « Grand Ouest against Leukemia », Angers, France.,Service d'hématologie clinique, CHU de Rennes, Rennes, France
| | - Patrice Chevalier
- Service d'hématologie clinique, CHU de Nantes, Rennes, France.,Federation hospitalo-universitaire « Grand Ouest against Leukemia », Angers, France
| | - Gaelle Guillerm
- Federation hospitalo-universitaire « Grand Ouest against Leukemia », Angers, France.,Service d'Hématologie Clinique, Hôpital Morvan, CHU de Brest, Rennes, France
| | - Emmanuel Gyan
- Federation hospitalo-universitaire « Grand Ouest against Leukemia », Angers, France.,Service d'Hématologie et Thérapie Cellulaire, Hôpital Bretonneau, CHRU de Tours, CNRS EMR7001 LNOx, Université de Tours, Rennes, France
| | - Aline Schmidt-Tanguy
- Service des maladies du sang, CHU d'Angers, Angers, France.,Federation hospitalo-universitaire « Grand Ouest against Leukemia », Angers, France.,Université d'Angers, Inserm UMR 1307, CNRS UMR 6075, Nantes Université, CRCI2NA, F-49000, Angers, France
| | - Roland B Walter
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA.,Department of Medicine, Division of Hematology/Oncology, University of Washington, Seattle, WA, USA.,Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA.,Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Mathilde Hunault-Berger
- Service des maladies du sang, CHU d'Angers, Angers, France.,Federation hospitalo-universitaire « Grand Ouest against Leukemia », Angers, France.,Université d'Angers, Inserm UMR 1307, CNRS UMR 6075, Nantes Université, CRCI2NA, F-49000, Angers, France
| | - Corentin Orvain
- Service des maladies du sang, CHU d'Angers, Angers, France. .,Federation hospitalo-universitaire « Grand Ouest against Leukemia », Angers, France. .,Université d'Angers, Inserm UMR 1307, CNRS UMR 6075, Nantes Université, CRCI2NA, F-49000, Angers, France.
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