The progress with intensive
chemotherapy and supportive care measures has improved survival in patients with newly diagnosed
acute myeloid leukemia (AML). Given the recent development of effective low intensity
therapies, an optimal decision on the
therapy intensity may improve survival through the avoidance of early mortality. We reviewed the outcome of 3728 patients with newly diagnosed AML who received intensive
chemotherapy between August 1980 and May 2020. Intensive
chemotherapy was defined as a cumulative
cytarabine dose ≥ 700 mg/m2 during induction
therapy. We divided the whole cohort into a training and validation group at a 3:1 ratio. The population was divided into a training (2790 patients) and a validation cohort (938 patients). The median age was 55 years (range, 15-99). Among them, 442 patients (12%) had
core-binding factor AML. Binary logistic regression identified older age, worse performance status,
hyperbilirubinemia, elevated
creatinine,
hyperuricemia,
cytogenetic abnormalities other than CBF and -Y, and
pneumonia as adverse prognostic factors for an early 4-week mortality. This risk classification for early mortality was verified in the validation cohort of patients. In the validation cohort of more recently treated patients from 2000 to 2017, the 4-week mortality rates with intensive
chemotherapy were 2%, 14%, and 50% in the low-, high-, and very high-risk group, respectively. The mortality rates with low intensity
therapies were 3%, 9%, and 20%, respectively. The risk classification guides treatment intensity by the assessment of age,
frailty, organ dysfunction,
cytogenetic abnormality, and
infection to avoid early mortality.