For patients with acute myeloid leukemia (AML) receiving intensive chemotherapy, AML-SCORE and PINA-Score help to estimate 1) complete remission and early death rate in patients ≥60 years and 2) probabilities of overall and relapse-free survival in patients with AML with normal karyotype.
SAL Study Alliance Leukemia
AMLCG

About PINA

PINAOS and PINARFS classify adult patients (≥ 18 years) with untreated AML and who are considered eligible for an intensive treatment approach into prognostic groups with different overall survival or relapse-free survival, respectively.

IMPORTANT NOTE: The PINAOS and PINARFS are validated only for patients with untreated AML and considered fit for an intensive treatment by their treating hematologists. PINARFS can only be applied for patients who have achieved a complete remission after induction therapy. These scores DO NOT apply to patients outside this population, i.e. with contraindications against an intensive AML induction therapy. Of note, these patients will not fulfill the AMLCG study inclusion parameters [4].

Based on the published algorithm [4], the following variables are used for the prognostic classification. The values of these variables are given in brackets:


NPM1 [5]
mutation status of the nucleophosmin gene
(not mutated, mutated)
 
FLT3-ITD [6]
internal tandem duplication in the fms-related tyrosine kinase 3 gene
(absent, present)
 
biCEBPA mutation [7,8]
biallelic mutation in the CCAAT/enhancer binding protein α gene
(absent, present)
 
WBC (G/L)
White blood count in 109 per liter
(numeric value, please use a dot as decimal separator, e.g. 4.5 G/L)
 
Age at diagnosis (years) (numeric value)  
ECOG* [9]
Performance status according to the Eastern Cooperative Group
(0,1,2,3,4)
 
  0 = fully active  
  1 = capable of light work  
  2 = capable of selfcare  
  3 = mostly confined to bed or chair  
  4 = completely disabled  
*only for the PINAOS    

The PINAOS and PINARFS risk definitions are as defined and published by the AMLCG (adapted from [4]):


PINAOS score=
-1.20 (if NPM1+, otherwise 0)-0.26 (if FLT3-ITD+, otherwise 0)+0.89 (if NPM1+ and FLT3-ITD+, otherwise 0)
-1.30 (if biCEBPA, otherwise 0)+0.57 x log10(1000*WBC [G/L])+0.044 x age [years]+0.40 (if ECOG 2-4, otherwise 0)


Definition of PINAOS groups              
Low Risk: PINSOS score       <4.0    
Intermediate Risk: PINAOS score       ≥4.0 and <5.4    
High Risk: PINAOS score       ≥5.4    

PINARFS score=
-1.61 (if NPM1+, otherwise 0)-0.44 (if FLT3-ITD+, otherwise 0)+1.24 (if NPM1+ and FLT3-ITD+, otherwise 0)
-1.34 (if biCEBPA, otherwise 0)+0.54 x log10(1000*WBC [G/L])+0.018 x age [years]


Definition of PINARFS groups              
Low Risk: PINARFS score       <2.0    
Intermediate Risk: PINARFS score       ≥2.0 and <2.9    
High Risk: PINARFS score       ≥2.9    

Clinical outcome in the patient population of the development of PINAOS and PINARFS [4].
Note: Overall survival (OS) is the time between first diagnosis and death from any cause. Relapse-free survival (RFS) is the time between achievement of a complete remission after first induction and relapse or death from any cause.


PINAOS:                    
Low Risk:       5-year OS probability: 74%          
Intermediate Risk:       5-year OS probability: 28%          
High Risk:       5-year OS probability: 3%          

PINARFS:                    
Low Risk:       5-year RFS probability: 55%          
Intermediate Risk:       5-year RFS probability: 27%          
High risk:       5-year RFS probability: 5%          

Important note: In case of missing values, the risk scores will not be calculated.