AML Composite Model Guides Treatment Decision-Making

09/11/17

A model that incorporates patient-specific characteristics for those with acute myeloid leukemia (AML) may help predict mortality after treatment, according to an investigation published in JAMA Oncology (online September 7, 2017;doi:10.1001/jamaoncol.2017.2714).

Mortality in AML can be contributed to factors such as inherited resistance to therapy as well as deleterious or lethal effects of treatment. Quantifying both of these risks is important for guiding treatment decision-making.

Mohamed L. Sorror, MD, MSc, clinical research division, Fred Hutchinson Cancer Research Center, University of Washington School of Medicine, and colleagues conducted a study to accurately estimate risks of mortality by developing and validating a composite model that combines patient- and AML-specific features. The retrospective study included patients randomly divided into a training set (n = 733) or a validation set (n = 367). Researchers analyzed factors such as comorbidities (including those already incorporated into the hematopoietic cell transplantation-comorbidity index [HCT-CI]), age, and cytogenetic and molecular risks and measured for mortality within 1-year after initial therapy for AML.

In the training set, covariates associated with 1-year overall mortality contributed to a multivariate Cox proportional hazards model in which the impact of each covariate was adjusted for that of all others. Adjusted hazard ratios were subsequently used as weights.

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Results of the investigation showed that comorbidities influenced 1-year survival of patients with AML, and comorbidities are best captured by an augmented HCT-CI. Additionally, the augmented HCT-CI—along with age, cytogenetic, and molecular risks—could be combined into a AML composite model that could guide treatment-decision making and trial design in AML.

Furthermore, a better understanding of physical, cognitive, and social health would help clarify the prognostic of aging, researchers acknowledged.

Regarding the importance of their findings, researchers concluded that "Targeting comorbidities with interventions alongside specific AML therapy might improve survival." In addition, they suggest constructing a web-based calculator to facilitate the future use of the composite model.
Zachary Bessette