In a context of therapeutic revolution in older adults with AML, it is becoming increasingly important to select patients for the various treatment options by taking account of short-term efficacy and toxicity as well as long-term survival. Here, the data from three European registries for 1,199 AML patients aged 70 years or older treated with intensive chemotherapy were used to develop a prognostic scoring system. The median follow-up was 50.8 months. In the training set of 636 patients, age, performance status, secondary AML, leukocytosis, and cytogenetics, as well as NPM1 mutations (without FLT3-ITD), were all significantly associated with overall survival, albeit not to the same degree. These factors were used to develop a score that predicts long-term overall survival. Three risk-groups were identified: a lower, intermediate and higher-risk score with predicted 5-year overall survival (OS) probabilities of ≥12% (n = 283, 51%; median OS = 18 months), 3–12% (n = 226, 41%; median OS = 9 months) and <3% (n = 47, 8%; median OS = 3 months), respectively. This scoring system was also significantly associated with complete remission, early death and relapse-free survival; performed similarly in the external validation cohort (n = 563) and showed a lower false-positive rate than previously published scores. The European Scoring System ≥70, easy for routine calculation, predicts long-term survival in older AML patients considered for intensive chemotherapy.
在老年急性髓系白血病治疗革新的背景下，通过综合考虑短期疗效与毒性以及长期生存情况，为不同治疗方案选择合适的患者正变得日益重要。本研究基于欧洲三大注册中心1199例接受强化化疗的70岁及以上AML患者数据，开发了一套预后评分系统。中位随访时间为50.8个月。在636例训练集患者中，年龄、体能状态、继发性AML、白细胞增多、细胞遗传学以及NPM1突变（不伴FLT3-ITD）均与总生存期显著相关，尽管影响程度不同。基于这些因素构建的评分可预测长期总生存期。系统划分出三个风险组：低危组（n=283，51%；中位OS=18个月）、中危组（n=226，41%；中位OS=9个月）和高危组（n=47，8%；中位OS=3个月），其预测5年总生存率分别为≥12%、3–12%和<3%。该评分系统同样与完全缓解率、早期死亡率和无复发生存期显著相关；在外部验证队列（n=563）中表现一致，且较既往发表的评分系统显示出更低的假阳性率。这套便于常规计算的欧洲≥70岁评分系统，能够有效预测考虑接受强化化疗的老年AML患者的长期生存结局。
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