Modest Prolongation of Survival for Patients 60-80 Year at Time of Acute Myelogenous Leukemia (AML) Diagnosis Who Are Treated with Conventional AML Therapy: A Provincial Cohort Analysis.
Bibliographic record
Abstract
Abstract Abstract 4125 Historically, treatment of AML has focused on intensive high dose comibination chemotherapy. Since AML is frequently diagnosed at an advanced age there is often concern that the morbidity of treatment outweighs benefit. In the province of Manitoba all patients with AML are referred and care is coordinated at one regional center. Through linkage of the provincial cancer registry and the clinical records at CancerCare Manitoba and the Manitoba Blood and Marrow Transplant Program a historical cohort of adults with newly diagnosed AML in Manitoba between 2001 and 2006 was assembled with complete treatment records and outcomes. During the 5 year period 185 adult patients were diagnosed with AML (median age at diagnosis 69y (range 17-96ys) with an age-adjusted incidence of 2.66 per 105. Remission Induction chemotherapy was generally offered to fit adult patients up to 80 years of age. The proportion of patients 60-80 ys at diagnosis who underwent conventional remission induction therapy was less than those <60 years old at diagnosis (24% (31/127) vs 76% (44/58)). While younger patients (<60y) were likely to enter CR 28/44 (64%) and had overall 3 y DFS of 35% this was frequently in the setting of allogeneic transplant (12 underwent HSCT in CR1 and 8 underwent HSCT in ≥ CR2). During this time period allogeneic transplantation was not offered for pts >60 y. For patients between 60-80 ys, receiving conventional induction therapy followed by HDAraC consolidation, 19/31 (61%) entered remission. There was a survival benefit (p<0.0001, Log Rank) as against supportive care. The decision to treat was made on a clinical assessment of ability to tolerate intensive chemotherapy but on analysis there was no difference in age, Karnofsky score or pretreatment WBC in those receiving treatment and not. The beneficial effect of induction therapy on OS remained significant (HR 2.367 95% CI 1.226 to 4.667, p=0.01) when adjusted for pre-treatment WBC, Karnofsky performance score and age. The magnitude of response was less than that seen with the younger cohort in that the median length of survival was 12 mo (range 6-26 mo) with no long term survivors. Cause of death in those entering remission was related to disease relapse in the majority of cases. In this population-based analysis, patients with AML ≥ 60 years have a modest survival benefit from conventional AML induction and consolidation. This needs to be tempered with the morbidity of treatment. Since allogeneic transplant is such an important tool in younger patients possible introduction of submyeloablative transplantation in those older adults entering CR may be appropriate. For the majority of older patients newer therapies that are better tolerated need to be explored. Disclosures: No relevant conflicts of interest to declare.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".