Prognosis of relapsed AML

Prognostic index for adults with first relapse of acute myeloid leukemia

Applies to adult patients aged 15 – 60 years with acute myeloid leukemia (except acute promyelocytic leukemia) in first relapse.

1. Sum the points for each risk factor

Prognostic factor0 points1 point2 points3 points5 points
Duration of remission prior to relapse (months)> 18--7 - 18< 7
Cytogenetics at initial diagnosisinv(16) or t(16;16)--t(8;21)other
Prior hematopoietic stem cell transplantationno-yes--
Age at time of relapse (years)≤ 3536 - 45> 45--

2. Assign risk category and determine prognosis

ScoreCategory% of patients1 yr OS5 yr OS
0 - 6Favourable risk9%70%46%
7 - 9Intermediate risk25%49%18%
10 - 14Unfavourable risk66%16%4%

This prognostic index was developed from a study of 667 patients aged 15 to 60 years with relapsed acute myeloid leukaemia (AML), excluding acute promyelocytic leukemia.1

Patients were originally diagnosed between 1987 and 2001, and had received their original treatment within consecutive trials of the Dutch-Belgian Hemato-Oncology Cooperative Group and the Swiss Group for Clinical Cancer Research Collaborative Group.

The strongest predictors of prognosis at relapse were relapse-free interval from time of first complete remission, and the cytogenetic findings at diagnosis.

Patients received a variety of treatments at relapse, but among those who achieved a second complete remission, the highest 5 year survival rates were seen in patients who underwent allogeneic stem cell transplant.