Comorbidity and performance status in acute myeloid leukemia patients: a nation-wide population-based cohort study

• Published in: Leukemia 2015-03, Vol.29 (3), p.548-555
• Main Authors: Østgård, L S G, Nørgaard, J M, Sengeløv, H, Severinsen, M, Friis, L S, Marcher, C W, Dufva, I H, Nørgaard, M
• Format: Article
• Language: English
• Subjects: 692/308/174; 692/699/1541/1990/283/1897; 692/699/67/1059/99; 692/700/1750; Acute myeloid leukemia; Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Antineoplastic Agents - therapeutic use; Cancer; Cancer Research; Cardiovascular Diseases - drug therapy; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - mortality; Cardiovascular Diseases - pathology; Chemotherapy; Chronic illnesses; Clinical decision making; Clinical trials; Cohort analysis; Cohort Studies; Comorbidity; Confidence intervals; Critical Care Medicine; Decision making; Denmark - epidemiology; Disease; Female; Hematology; Hospitals; Humans; Intensive; Internal Medicine; Leukemia; Leukemia, Myeloid, Acute - drug therapy; Leukemia, Myeloid, Acute - epidemiology; Leukemia, Myeloid, Acute - mortality; Leukemia, Myeloid, Acute - pathology; Lung Diseases - drug therapy; Lung Diseases - epidemiology; Lung Diseases - mortality; Lung Diseases - pathology; Male; Medical prognosis; Medical research; Medical statistics; Medicine; Medicine & Public Health; Medicine, Experimental; Middle Aged; Mortality; Myeloid leukemia; Oncology; original-article; Patient outcomes; Population; Population studies; Population-based studies; Registries; Remission; Remission (Medicine); Remission Induction; Survival Analysis; World population
• ISSN: 0887-6924; 1476-5551
• DOI: 10.1038/leu.2014.234

As the world population ages, the comorbidity burden in acute myeloid leukemia (AML) patients increases. Evidence on how to integrate comorbidity measures into clinical decision-making is sparse. We determined the prognostic impact of comorbidity and World Health Organization Performance Status (PS) on achievement of complete remission and mortality in all Danish AML patients treated between 2000 and 2012 overall and stratified by age. Comorbidity was measured using a modified version of the Charlson Comorbidity Index, with separate adjustment for pre-leukemic conditions. Of 2792 patients, 1467 (52.5%) were allocated to intensive therapy. Of these patients, 76% did not have any comorbidities, 19% had one comorbid disease and 6% had two or more comorbidities. Low complete remission rates were associated with poor PS but not with comorbidity. Surprisingly, among all intensive therapy patients, presence of comorbidity was not associated with an increased short-term mortality (adjusted 90 day mortality rate (MR)=1.06 (95% confidence interval (CI)=0.76–1.48)) and, if any, only a slight increase in long-term mortality (91 day–3 year adjusted MR=1.18 (95%CI=0.97–1.44). Poor PS was strongly associated with an increased short- and long-term mortality (adjusted 90 day MR, PS⩾2=3.43 (95%CI=2.30–5.13); adjusted 91 day–3 year MR=1.35 (95%CI=1.06–1.74)). We propose that more patients with comorbidity may benefit from intensive chemotherapy.