Prognosis and survival for acute myeloid leukemia

A prognosis is the doctor's best estimate of how cancer will affect a person and how it will respond to treatment. Prognosis and survival depend on many factors. Only a doctor familiar with your medical history, the type and stage and other features of the cancer, the treatments chosen and the response to treatment can put all of this information together with survival statistics to arrive at a prognosis.

To get a prognosis, the doctor will look at certain aspects of the cancer or a characteristic of the person (such as their age and if they have other illnesses). These aspects are called prognostic factors.

The doctor will also look at predictive factors, which influence how a cancer will respond to a certain treatment.

Prognostic and predictive factors are often discussed together. They both play a part in deciding on a prognosis and a treatment plan. The following are prognostic and predictive factors for acute myeloid leukemia (AML).

AML can be classified into many different subtypes. The subtype can be important to help determine your prognosis and plan your treatment.

Certain subtypes, such as acute promyelocytic leukemia (APL), have higher survival statistics than others. Other subtypes may have certain characteristics such as gene and chromosome changes that can also affect your prognosis.

Find out more about classification of AML.

Many chromosome changes or molecular genetic changes are linked with AML, and some of them are used as prognostic factors. These changes can help determine how AML will respond to treatment and whether or not it has a high risk of coming back after treatment.

Favourable or good-risk changes include:

• translocation between chromosomes 8 and 21, RUNX1-RUNX1T1

• translocation or inversion of chromosome 16, CBFB-MYH11

• mutated NPM1 without FLT3-ITD or with FLT3-ITD low allelic ration (<0.5)

• biallelic mutated CEBPA

Intermediate-risk changes include:

• mutated NPM1 and FLT3-ITD high

• wild-type NPM1 without FLT3-ITD or with FLT3-ITD low

• translocation between chromosomes 9 and 11 resulting in MLLT3-KMT2A

Unfavourable or high-risk changes include:

• translocation between chromosomes 6 and 9 resulting in DEK-NUP214

• translocation at band 11q23/3 resulting in KMT2A rearranged

• translocation between chromosomes 9 and 22 resulting in BCR-ABL1

• translocation or inversion of chromosome 3 resulting in GATA2,MECOME(EVI1)

• deletion of part of chromosome 5, 7 or 17

• complex karyotype, monosomal karyotype

• wild-type NPM1 and FLT3-ITD high

• mutated RUNX1

• mutated ASXL1

• mutated TP53

AML that develops after treatment for another cancer usually has a less favourable prognosis.

People who have already had a blood disorder, such as a myelodysplastic syndrome (MDS), usually have a less favourable prognosis.

How well leukemia responds to treatment is an important prognostic factor. The response to chemotherapy is measured as the time it takes to reach a complete remission, or complete response. The goal of treatment is to reach a complete remission.

People with AML that responds quickly to treatment (goes into complete remission after one round of induction chemotherapy) have a better prognosis than people with AML that does not respond quickly or needs more than one cycle of chemotherapy to go into remission.

Disease that is still present after treatment but can only be found using more sensitive tests is called measurable residual disease (MRD). People with MRD at the end of induction chemotherapy have a higher risk of relapse and a poorer prognosis than people with no MRD after induction chemotherapy.

An early relapse is also linked with a less favourable prognosis.

Find out more about terms used to describe response to treatment in staging for AML.

Younger adults, usually those younger than 60 years of age, have a more favourable prognosis than older adults. Older people tend to have more unfavourable genetic changes than younger people. Older people may also have health conditions that make it hard for them to cope with the intense treatments for AML.

A white blood cell (WBC) count of more than 100,000 cells/mm³ at the time of diagnosis is linked with a less favourable prognosis.

A serious, uncontrolled infection at the time of diagnosis is a less favourable prognostic factor.