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

About AML

About the AML risk score prediction

The algorithm predicts the chance of the achievement of a complete remission and the risk for an early death for elderly patients (60 years and older) with untreated AML and who are considered eligible for an intensive treatment approach.

The scores presented and calculated herein are validated only for patients 60 years or older with untreated AML and considered fit for an intensive treatment by their treating hematologists. These scores DO NOT apply to patients outside this population, i.e. younger than 60 years or with contraindications against an intensive AML induction therapy.

Based on the algorithm presented on the annual meeting of the American Society of Hematology 2010 and published [1], the following parameters are included in the risk prediction. The stratification of these parameters are given in brackets:

Body temperature (°C) (≤38, >38)
Hemoglobin (g/dl) (≤10.3, >10.3)
Platelets (K/µl) (≤28, >28-≤53, >53-≤104, >104)
Fibrinogen (mg/dl) (≤150, >150)
Age at diagnosis (years) (60-64, >64-67, >67-72, >72)
Type of leukemia (de novo, secondary)

If available, additional information about the cytogenetic and molecular risk increases the validity of the scores. The Cytogenetic and molecular risk is classified into the following groups:

Low cytogenetic risk OR low molecular risk (normal karyotype and mutated Nucleophosmin [NPM1] and no Flt3-ITD mutation).

Intermediate normal:
Normal karyotype, intermediate molecular risk (all other combinations of NPM1 / Flt3 mutational status OR unknown mutational status).

Intermediate, not normal:
Intermediate cytogenetic risk, abnormal karyotype.

High cytogenetic risk.

Definition of the AML risk scores

The cytogenetic risk definitions are as defined and published by the AMLCG [2,3] as follows:

Low risk:
Presence of a t(8;21)(q22;q22) and / or detection of an AML1-ETO translocation product, independent from additional cytogenetic findings. Presence of an inv(16)(p13p22) or a t(16;16)(p13;p22) and / or detection of a CBFβ-MYH11 translocation product, independent from additional cytogenetic findings.

High risk:
presence of a del(5q) or monosomy 5, del(7q) or monosomy 7, inv(3)(q21q26.2) or t(3;3)(q21;q26.2), 11q23 aberrations, or complex-aberrant karyotype comprising of three or more aberrations not involving low-risk aberrations.

Intermediate risk:
all other aberrations.

Important note: In case of missing values, the risk scores will still be calculated by setting the missing values to the median of the evaluation population.