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ACUTE MYELOID LEUKEMIA

Comparison of scoring systems evaluating suitability for intensive chemotherapy in adults with acute myeloid leukemia—a Grand Ouest Against Leukemia (GOAL) study

Leukemia volume 36, pages 2408–2417 (2022)Cite this article

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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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Fig. 1: Distribution of predictive scoring systems by early (28-day and 56-day) mortality. The proportion of patients with early mortality is represented for individual patient categories, as stratified by scoring systems.
Fig. 2: Outcome of patients stratified by each scoring ssytems.
Fig. 3: Time AUC and Brier score for prediction of mortality over time for different scoring systems.

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Acknowledgements

We would like to acknowledge all the medical teams and pharmacists from each participating center for their help on identifying patients and collecting data.

Author information

Authors and Affiliations

  1. Service des maladies du sang, CHU d’Angers, Angers, France

    Christophe Desprez, Aline Schmidt-Tanguy, Mathilde Hunault-Berger & Corentin Orvain

  2. Univ Angers, CHU Angers, Inserm, CNRS, MINT, SFR ICAT, Angers, France

    Jérémie Riou

  3. Service d’hématologie clinique, CHU de Nantes, Rennes, France

    Pierre Peterlin & Patrice Chevalier

  4. Federation hospitalo-universitaire « Grand Ouest against Leukemia », Angers, France

    Pierre Peterlin, Tony Marchand, Marie-Anne Couturier, Alban Villate, Jean-Baptiste Mear, Patrice Chevalier, Gaelle Guillerm, Emmanuel Gyan, Aline Schmidt-Tanguy, Mathilde Hunault-Berger & Corentin Orvain

  5. Service d’hématologie clinique, CHU de Rennes, Rennes, France

    Tony Marchand & Jean-Baptiste Mear

  6. INSERM U1236, Université Rennes 1, Rennes, France

    Tony Marchand

  7. Service d’Hématologie Clinique, Hôpital Morvan, CHU de Brest, Rennes, France

    Marie-Anne Couturier & Gaelle Guillerm

  8. Service d’Hématologie et Thérapie Cellulaire, Hôpital Bretonneau, CHRU de Tours, CNRS EMR7001 LNOx, Université de Tours, Rennes, France

    Alban Villate & Emmanuel Gyan

  9. Université d’Angers, Inserm UMR 1307, CNRS UMR 6075, Nantes Université, CRCI2NA, F-49000, Angers, France

    Aline Schmidt-Tanguy, Mathilde Hunault-Berger & Corentin Orvain

  10. Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA

    Roland B. Walter

  11. Department of Medicine, Division of Hematology/Oncology, University of Washington, Seattle, WA, USA

    Roland B. Walter

  12. Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA

    Roland B. Walter

  13. Department of Epidemiology, University of Washington, Seattle, WA, USA

    Roland B. Walter

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  1. Christophe Desprez
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Contributions

Conception and Design: CD, CO. Collection and Assembly of Data: CD, PP, TM, MAC, AV, JBM, PC, GG, EG. Data Analysis and Interpretation: CD, JR, ATS, RBW, MHB, CO. Manuscript Writing: All authors. Final Approval of the Manuscript: All authors.

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Correspondence to Corentin Orvain.

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Competing interests

Employment or Leadership Position: none; Consultant or Advisory Role: MHB, Erytech©; Stock Ownership: none; MHB, Abbvie, Incyte, and Jazz Pharmaceuticals, CO, Novartis; Research Funding: none; Expert Testimony: none; Patents: none; Other Remuneration: none.

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Desprez, C., Riou, J., Peterlin, P. et al. Comparison of scoring systems evaluating suitability for intensive chemotherapy in adults with acute myeloid leukemia—a Grand Ouest Against Leukemia (GOAL) study. Leukemia 36, 2408–2417 (2022). https://doi.org/10.1038/s41375-022-01677-z

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