Acute myeloid leukemia (AML) is an aggressive, life-threatening disease, and its risk increases with age. However, older AML patients (60 [+] (sic) years) have shorter survival after diagnosis compared to younger patients, mainly because of suboptimal treatment of their leukemia. Physicians may not recommend intensive initial treatments that have the potential of curing the disease because they believe their patients may die from the treatment itself. Likewise, while investigators have developed minimally toxic chemotherapy regimens to prepare patients for a potentially curative procedure, [namely] (sic) blood or marrow transplantation from a donor, there has been reluctance in offering this procedure to older patients. Physicians often use an age cutoff of 60 years to determine whether a patient is likely to benefit from curative treatments. But age above or below 60 years [in itself] (sic) is not an accurate assessment of risks, since some patients in their 60s are healthier than others in their 50s. Organ dysfunctions (comorbidities) are probably more relevant in determining how patients will tolerate treatment than age itself. We have shown that measuring comorbidities before blood or marrow transplantation can help more accurately predict whether a patient will survive the transplant.
We would now like to test whether measuring comorbidities in AML patients can predict whether treatment will be successful, and provide physicians, patients and their families with a better understanding of the risks and benefits of their treatment options. We will then use comorbidities and other risk factors to assess new patients for the appropriateness of marrow transplantation and how it compares to chemotherapy in regards to survival and quality of life. We will conduct a series of three studies to address these issues. One study will review the charts of 2,000 people with AML treated at four hospitals. This information will allow us to develop a comorbidity index that is specific for AML patients, and to incorporate this index with other factors [such as] (sic) AML disease features, into a risk-stratification strategy for mortality. A second study will enroll 1,000 people who are [recently] (sic) diagnosed with AML. We will follow this group very closely and ask them and their physicians questions over time to understand how they are making their treatment decisions, and whether their chosen treatments are successful. The final study will compare the survival and quality of life between those who choose the most intensive treatments and those who choose less intensive treatments. The results of these studies will significantly advance our knowledge about how to tailor treatments so that we recommend intensive treatments to those who can tolerate them, but suggest less intensive treatments to those whom we will only harm. It will also provide a better understanding of how successful the different treatments are in curing AML, and the quality of life people experience during and after treatment.