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.

已经开发了几种评分系统来评估个体患者对强化急性髓性白血病 (AML) 治疗的适用性。我们试图在法国五个学术中心接受常规诱导化疗的 428 名连续 AML 成人队列中比较这些评分的表现。所有评分系统都确定了 28 天和 56 天死亡率增加的患者子集，尽管预测准确性总体上受到限制，C 统计量在 0.61 至 0.71 之间- 相关参数。根据最近随机试验中使用的标准，104 名患者 (24%) 被认为不适合强化化疗的结果与其他 324 名患者的结果相似（28 天死亡率，优势比 [OR] = 1.88，P  = 0.2；56 天死亡率，OR = 1.71，P  = 0.21；无事件生存，风险比 [HR] = 1.08，P  = 0.6；OS，HR = 1.25，P  = 0.14），低歧视（C 统计量：28 天、56 天死亡率、EFS 和 OS 分别为 0.57、0.56、0.50 和 0.52）。总之，我们的研究结果表明，目前可用的方法来识别强化 AML 治疗后早期死亡风险增加和生存期缩短的患者的准确性相对有限。在临床决策中应谨慎使用可用的评分系统。