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


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

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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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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).

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