Haematologica (Jan 2022)

A risk score based on real-world data to predict early death in acute promyelocytic leukemia

  • Albin Österroos,
  • Tânia Maia,
  • Anna Eriksson,
  • Martin Jädersten,
  • Vladimir Lazarevic,
  • Lovisa Wennström,
  • Petar Antunovic,
  • Jörg Cammenga,
  • Stefan Deneberg,
  • Fryderyk Lorenz,
  • Lars Möllgård,
  • Bertil Uggla,
  • Emma Ölander,
  • Eliana Aguiar,
  • Fernanda Trigo,
  • Martin Höglund,
  • Gunnar Juliusson,
  • Sören Lehmann

DOI
https://doi.org/10.3324/haematol.2021.280093
Journal volume & issue
Vol. 107, no. 7

Abstract

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With increasingly effective treatments, early death (ED) has become the predominant reason for therapeutic failure in patients with acute promyelocytic leukemia (APL). To better prevent ED, patients with high-risk of ED must be identified. Our aim was to develop a score that predicts the risk of ED in a real-life setting. We used APL patients in the populationbased Swedish AML Registry (n=301) and a Portuguese hospital-based registry (n=129) as training and validation cohorts, respectively. The cohorts were comparable with respect to age (median, 54 and 53 years) and ED rate (19.6% and 18.6%). The score was developed by logistic regression analyses, risk-per-quantile assessment and scoring based on ridge regression coefficients from multivariable penalized logistic regression analysis. White blood cell count, platelet count and age were selected by this approach as the most significant variables for predicting ED. The score identified low-, high- and very high-risk patients with ED risks of 4.8%, 20.2% and 50.9% respectively in the training cohort and with 6.7%, 25.0% and 36.0% as corresponding values for the validation cohort. The score identified an increased risk of ED already at sub-normal and normal white blood cell counts and, consequently, it was better at predicting ED risk than the Sanz score (AUROC 0.77 vs. 0.64). In summary, we here present an externally validated and population-based risk score to predict ED risk in a real-world setting, identifying patients with the most urgent need of aggressive ED prevention. The results also suggest that increased vigilance for ED is already necessary at sub-normal/normal white blood cell counts.