The progress with intensive chemotherapy and supportive care measures has improved survival in patients with newly diagnosed acute myeloid leukemia (AML). Given the recent development of effective low intensity therapies, an optimal decision on the therapy intensity may improve survival through the avoidance of early mortality. We reviewed the outcome of 3728 patients with newly diagnosed AML who received intensive chemotherapy between August 1980 and May 2020. Intensive chemotherapy was defined as a cumulative cytarabine dose ≥ 700 mg/m² during induction therapy. We divided the whole cohort into a training and validation group at a 3:1 ratio. The population was divided into a training (2790 patients) and a validation cohort (938 patients). The median age was 55 years (range, 15-99). Among them, 442 patients (12%) had core-binding factor AML. Binary logistic regression identified older age, worse performance status, hyperbilirubinemia, elevated creatinine, hyperuricemia, cytogenetic abnormalities other than CBF and -Y, and pneumonia as adverse prognostic factors for an early 4-week mortality. This risk classification for early mortality was verified in the validation cohort of patients. In the validation cohort of more recently treated patients from 2000 to 2017, the 4-week mortality rates with intensive chemotherapy were 2%, 14%, and 50% in the low-, high-, and very high-risk group, respectively. The mortality rates with low intensity therapies were 3%, 9%, and 20%, respectively. The risk classification guides treatment intensity by the assessment of age, frailty, organ dysfunction, cytogenetic abnormality, and infection to avoid early mortality.

中文翻译：

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强化化疗对急性髓细胞白血病早期（4周）死亡率的预测

强化化疗和支持性护理措施的进展提高了新诊断的急性髓性白血病 (AML) 患者的生存率。鉴于最近有效的低强度疗法的发展，对治疗强度的最佳决策可以通过避免早期死亡率来提高生存率。我们回顾了 1980 年 8 月至 2020 年 5 月期间接受强化化疗的 3728 名新诊断 AML 患者的结果。强化化疗定义为阿糖胞苷的累积剂量 ≥ 700 mg/m ²在诱导治疗期间。我们以 3:1 的比例将整个队列分为训练组和验证组。人群分为训练组（2790 名患者）和验证组（938 名患者）。中位年龄为 55 岁（范围 15-99）。其中，442 名患者（12%）患有核心结合因子 AML。二元逻辑回归确定年龄较大、体力状态较差、高胆红素血症、肌酐升高、高尿酸血症、除 CBF 和 -Y 以外的细胞遗传学异常以及肺炎是早期 4 周死亡率的不良预后因素。这种早期死亡的风险分类在患者的验证队列中得到了验证。在 2000 年至 2017 年最近接受治疗的患者的验证队列中，强化化疗的 4 周死亡率分别为 2%、14% 和 50%，低、高、和非常高风险的群体，分别。低强度治疗的死亡率分别为 3%、9% 和 20%。风险分类通过评估年龄、虚弱、器官功能障碍、细胞遗传学异常和感染来指导治疗强度，以避免早期死亡。