Value of Different Comorbidity Indices for Predicting Outcome in Patients with Acute Myeloid Leukemia

• Published in: PloS one Vol. 11; no. 10; p. e0164587
• Main Authors: Wass, Maxi, Hitz, Friederike, Schaffrath, Judith, Müller-Tidow, Carsten, Müller, Lutz P
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 12.10.2016; Public Library of Science (PLoS)
• Subjects: Acute myelocytic leukemia; Acute myeloid leukemia; Adolescent; Adult; Adults; Age; Age Factors; Aged; Aged, 80 and over; Analysis; Biology and Life Sciences; Cancer therapies; Cardiovascular diseases; Chemotherapy; Comorbidity; Cytogenetic Analysis; Cytogenetics; Demographics; Demography; Disease; Female; Geriatrics; Hematopoietic stem cell transplantation; Hematopoietic Stem Cell Transplantation - adverse effects; Humans; Kidneys; Leukemia; Leukemia, Myeloid, Acute - diagnosis; Leukemia, Myeloid, Acute - epidemiology; Leukemia, Myeloid, Acute - genetics; Leukemia, Myeloid, Acute - therapy; Liver diseases; Male; Medical prognosis; Medical research; Medicine and Health Sciences; Middle Aged; Mortality; Multivariate analysis; Myeloid leukemia; Patient outcomes; Patients; People and Places; Physical Sciences; Pneumoviridae; Prognosis; Renal function; Research and Analysis Methods; Retrospective Studies; Statistical analysis; Stem cell transplantation; Survival; Survival Analysis; Transplantation; Treatment Outcome; Young Adult
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0164587

Age is a dominant predictor of outcome in acute myeloid leukemia (AML). However, it is not clear to which extent comorbidities contribute to this effect. The objective of this study was to determine the impact of pretreatment comorbidities on survival of AML patients. In a single-center retrospective study 194 adult AML patients were included. The Hematopoietic cell transplantation comorbidity index (HCT-CI), the Adult Comorbidity Evaluation-27 (ACE-27) score and the Cumulative Illness Rating Scale for Geriatrics (CIRS-G) as well as data on demographics, cytogenetics, treatment and outcome were evaluated at the time of initial diagnosis by univariate and multivariate analysis. The study included 102 male and 92 female (median age 60.9 years) of which 173 (89.2%) received intensive chemotherapy. Median overall survival (OS) was 17 months. In univariate analysis, cardiovascular disease (26 vs 12 months, p = .005), severe hepatic disease (19 vs 4 months, p = .013) and renal impairment (17 vs 7 months, p = .016) was associated with inferior OS. For each index, the highest comorbidity burden was associated with reduced OS. However, in multivariate analysis only the ACE-27 score was associated with outcome. Besides ECOG ≥ 2 and poor cytogenetics only the ACE-27 score but not higher age was associated with OS in the group of patients receiving intensive therapy. Adjusted hazard ratios were 3.1, 3.5 and 4.0 for mild, moderate and severe ACE-27-assessed comorbidities, respectively (p = .012). Our study confirms that comorbidities significantly impact survival of AML patients and a pretreatment assessment of comorbidities may help to identify patients with poor outcome.