1. A Scoring System To Predict The Risk Of Death During Induction Chemotherapy For De Novo Acute Myeloid Leukemia. 1David Valcárcel, 2Pau Montesinos, 3Isabel Sánchez- Ortega, 1Salut Brunet, 4Jordi Esteve, 2David M. Cuadrón, 5José M. Ribera, 6Mar Tormo, 7Javier Bueno, 8Rafael Duarte, 9Andrés Llorente, 10P. Torres, 11Ramón Guardia, 2Miguel A Sanz, and 1Jorge Sierra; on behalf of the CETLAM Group.

2. Background Induction chemotherapy of acute myeloid leukemia (AML), the first step to cure this disease, is associated to substantial mortality due to infections, hemorrhages up to 10-20% of patients die during induction phase the identification of patients at high risk of induction death (ID) may allow the individualization of the chemotherapy regimens and supportive measures 2

3. Background risk factors associated to higher rates of ID  older age, high leukocyte count, and bad performance status only few studies designed to build scoring systems to predict accurately the risk of ID often including a high number of variables and may not be easy to use in the daily clinical practice none has been validated in an external cohort of AML patients

4. Objectives identify the risk factors for ID in a large cohort of 570 consecutive patients treated between 1999 and 2006 in 20 Spanish centers of the CETLAM group Using these risk factors, we aim to build a scoring system to predict ID The external validity of the scoring system was tested in an independent set of patients from a single institution

5. Performance status / Comorbilidad Superv. Global Grupo ECOGBaja Charlson comorbidity index (CCI)Baja Hematopoietic cell transplantation comorbidity index (HCT-CI)Baja Estado general y Pronóstico tras QT intensiva en pacientes mayores de 60-70 años con SMD/LMA Tasa de RC Baja ND No. Ptes 998 133 177 Kantarjian H, et al. Cancer 2006; 106:1090-1198. Etienne A, et al. Cancer 2007; 109:1376-1383. Giles FJ, et al. Br J Haematol 2007; 136:624-627.

6. SG tras QT intensiva en LMA/SMD según HCT-CI GilesFJ, et al. Br J Haematol 2007; 136:624-627.

7. Methods and Patients 570 patients included in two multicenter trials of the CETLAM Group to develop a scoring system (study cohort) The scoring system was tested in 209 consecutive patients from an external single institution (validation cohort) induction regimens consisted of anthracycline and cytarabine combination with or without etoposide ID was defined as death in the first 42 days without evidence of leukemic resistance.

13. P<0.001 Low-risk Intermediate-risk High-risk Figure 1

14. P<0.001 Low-risk Intermediate-risk High-risk Figure 2

15. Conclusions our validated scoring system allows easy risk stratification for ID in the clinical setting However, our scoring system is not optimal for the risk-adapted implementation of specific supportive measures

16. Conclusions may be helpful to design risk-adapted induction strategies But patient selection depends also on some variables predicting ID (comorbidities, PS, and other) leukemic characteristics affecting the chances to achieve a CR (cytogenetics and FLT3-ITD mutations), as well as other circumstances (e.g., patient, family and physician preferences), will also influence the patient selection