Ostra białaczka szpikowa
Rokowania, prognozy i postęp choroby

Ostra białaczka szpikowa (AML) cechuje się wysoką heterogennością biologiczną i zmiennym rokowaniem, które zależy od złożonej interakcji czynników cytogenetycznych, molekularnych, klinicznych oraz odpowiedzi na leczenie. Kluczowe zmiany cytogenetyczne o korzystnym rokowaniu to m.in. t(8;21), t(15;17) (APL) oraz inv(16), natomiast niekorzystne obejmują t(6;9)(p23.3;q34.1), złożony kariotyp (CK-AML) i aberracje 11q23/KMT2A. Mutacje genetyczne takie jak NPM1 i bialleliczne CEBPA wiążą się z lepszym rokowaniem, podczas gdy mutacje FLT3-ITD, TP53, ASXL1, U2AF1 i RUNX1 predysponują do gorszych wyników. Wiek pacjenta jest silnym niezależnym czynnikiem prognostycznym – 5-letnie przeżycie spada z około 60% u osób poniżej 40 lat do około 1% u pacjentów powyżej 80 lat. Wskaźnik całkowitej remisji (CR) u młodszych dorosłych (<60 lat) wynosi około 67%, z medianą przeżycia 68 tygodni, natomiast u starszych (>60 lat) CR to około 55%, a mediana przeżycia 33 tygodnie. Typ AML (de novo, wtórna, związana z terapią) oraz obecność minimalnej choroby resztkowej (MRD) po leczeniu mają istotny wpływ na rokowanie i decyzje terapeutyczne.

Prognostyczne czynniki w ostrej białaczce szpikowej

Ostra białaczka szpikowa (AML) jest złożoną chorobą hematologiczną charakteryzującą się wysoką heterogennością i zmiennym rokowaniem. Prognoza w AML zależy od wielu czynników, które wspólnie określają szansę pacjenta na osiągnięcie remisji i długotrwałe przeżycie. Dokładna ocena prognostyczna wymaga kompleksowego podejścia obejmującego czynniki biologiczne, kliniczne oraz odpowiedź na leczenie.12

Znaczenie czynników genetycznych

Charakterystyka cytogenetyczna i molekularna odgrywa kluczową rolę w określaniu rokowania u pacjentów z AML. Pacjenci są klasyfikowani do kategorii ryzyka korzystnego, pośredniego lub niekorzystnego na podstawie zmian chromosomalnych i molekularnych.34

Do zmian cytogenetycznych związanych z korzystnym rokowaniem należą:45

Niekorzystne zmiany cytogenetyczne obejmują:45

Określone mutacje genetyczne mają również istotne znaczenie prognostyczne:64

  • Mutacje NPM1 – zazwyczaj związane z lepszym rokowaniem, szczególnie przy braku FLT3-ITD
  • Mutacje CEBPA (bialleliczne) – związane z korzystnym rokowaniem
  • Mutacje FLT3-ITD – zwykle związane z gorszym rokowaniem
  • Mutacje TP53 – silnie związane z gorszym rokowaniem, często współwystępują z CK-AML
  • Mutacje ASXL1 i U2AF1 – związane z wyższym ryzykiem i gorszym rokowaniem
  • Mutacje RUNX1 – związane z niższymi wskaźnikami remisji i krótszym przeżyciem

Wiek a rokowanie

Wiek jest jednym z najsilniejszych niezależnych czynników prognostycznych w AML. Młodsi pacjenci mają generalnie lepsze rokowanie niż pacjenci starsi.78

Pięcioletnie przeżycie według grup wiekowych:89

  • Poniżej 40 lat: około 60%
  • 40-49 lat: około 55%
  • 50-59 lat: około 35%
  • 60-69 lat: ponad 15%
  • 70-79 lat: około 5%
  • 80 lat i więcej: około 1%

Względny wskaźnik 5-letniego przeżycia dla wszystkich pacjentów z AML w Kanadzie wynosi około 23%, a w Stanach Zjednoczonych około 27%.102 W przypadku młodszych dorosłych (poniżej 60 lat) wskaźnik całkowitej remisji (CR) sięga 67%, a mediana przeżycia całkowitego wynosi około 68 tygodni. Dla pacjentów starszych (powyżej 60 lat) wskaźnik CR wynosi około 55%, a mediana przeżycia około 33 tygodni.11

Pochodzenie AML

Typ AML ma istotny wpływ na rokowanie:13

  • AML de novo (pierwotna) – lepsze rokowanie niż AML wtórna
  • AML wtórna (rozwijająca się po wcześniejszych zaburzeniach hematologicznych, np. zespole mielodysplastycznym) – gorsze rokowanie
  • AML związana z terapią (t-AML, rozwijająca się po leczeniu innego nowotworu) – znacząco gorsze rokowanie
  • Ostra białaczka promielocytowa (APL, podtyp AML z translokacją t(15;17)) – znacznie lepsze rokowanie, z 10-letnim przeżyciem sięgającym 80% przy leczeniu kwasem all-trans retynowym i trójtlenkiem arsenu

Czynniki kliniczne

Do klinicznych czynników prognostycznych należą:74

  • Liczba białych krwinek (WBC) przy rozpoznaniu – liczba WBC >100 000/mm³ wiąże się z gorszym rokowaniem
  • Obecność infekcji w momencie diagnozy – niekontrolowane zakażenie jest negatywnym czynnikiem prognostycznym
  • Stan sprawności (PS) – gorszy stan sprawności koreluje z gorszym rokowaniem
  • Choroby współistniejące – wyższy indeks chorób współistniejących wiąże się ze zwiększoną śmiertelnością
  • Obecność komórek białaczkowych w ośrodkowym układzie nerwowym – związana z gorszym rokowaniem

Niedawne badania wykazały, że zarówno osłabienie sprawności fizycznej, jak i funkcji poznawczych są niezależnie związane z gorszym przeżyciem, szczególnie u starszych pacjentów z AML.12

Odpowiedź na leczenie

Odpowiedź na leczenie stanowi krytyczny czynnik prognostyczny:79

  • Pacjenci, u których szybko uzyskano remisję (całkowita remisja po jednym cyklu chemioterapii indukcyjnej), mają lepsze rokowanie
  • Pacjenci wymagający więcej niż jednego cyklu chemioterapii do osiągnięcia remisji mają gorsze rokowanie
  • Wczesny nawrót choroby jest związany z gorszym rokowaniem

Obecność minimalnej choroby resztkowej (MRD) po leczeniu, wykrywana za pomocą cytometrii przepływowej lub technik molekularnych (PCR), jest silnym predyktorem nawrotu i gorszego przeżycia.413 Na przykład, utrzymujące się podwyższone poziomy RUNX1-RUNX1T1 mimo terapii indukcyjnej u pacjentów z AML z t(8;21) są związane ze zwiększonym ryzykiem nawrotu.4

Czas od diagnozy do rozpoczęcia leczenia

Czas od diagnozy AML do rozpoczęcia leczenia (TDT) ma różny wpływ w zależności od wieku pacjenta:1114

  • U pacjentów poniżej 60 roku życia, dłuższy TDT jest związany z gorszymi wskaźnikami CR i OS, zarówno w analizach jednowymiarowych, jak i wielowymiarowych
  • CR i OS zmniejszają się bardziej dramatycznie przy TDT 5 lub więcej dni u młodszych dorosłych
  • U pacjentów powyżej 60 roku życia, TDT nie ma istotnego wpływu na wyniki leczenia

Wyniki te sugerują, że u młodszych pacjentów terapia AML powinna być rozpoczęta natychmiast, podczas gdy opóźnienie leczenia u starszych pacjentów może nie być szkodliwe, pozwalając na zindywidualizowane podejście.11

Czynniki socjoekonomiczne

Czynniki socjoekonomiczne, takie jak status ubezpieczenia, również wpływają na rokowanie w AML:15

  • Pacjenci z prywatnym ubezpieczeniem mają wyższy wskaźnik przeżycia 24-miesięcznego (37,6%) w porównaniu do pacjentów nieubezpieczonych (31,8%) lub ubezpieczonych w ramach Medicaid (33,1%)
  • Status ubezpieczenia pozostaje istotnym predyktorem przeżycia całkowitego po uwzględnieniu innych czynników prognostycznych

Inne badania wykazały, że pacjenci leczeni w ośrodkach o wyższej liczbie przypadków AML mają lepsze rokowanie niż ci leczeni w ośrodkach z najniższego kwartyla pod względem liczby leczonych pacjentów.5

Modele prognostyczne w AML

W ostatnich latach opracowano kilka modeli prognostycznych integrujących różne czynniki w celu lepszego przewidywania wyników leczenia AML.1617

Modele nomogramów

Nomogramy prognostyczne są coraz częściej stosowane do indywidualnej oceny ryzyka:161718

  • Zindywidualizowane nomogramy prognostyczne mogą przewidywać przeżycie specyficzne dla raka (CSS) i przeżycie całkowite (OS) z relatywnie wysoką dokładnością
  • W jednym z badań, wskaźniki C nomogramów w walidacji wewnętrznej dla CSS i OS wynosiły odpowiednio 0,712 i 0,703
  • Nomogramy dla AML z t(9;11)(p22;q23) uwzględniają kluczowe zmienne takie jak wiek, rasa, pierwszy pierwotny guz i chemioterapia

Inny model prognostyczny opracowany dla osób starszych z AML zidentyfikował grupę wysokiego ryzyka z wskaźnikiem CR 20% u pacjentów z mutacją TP53, w porównaniu do 97% CR w grupie niskiego ryzyka definiowanej przez wysoką ekspresję ZBTB7A i EEPD1 bez mutacji TP53.19

Zintegrowana stratyfikacja ryzyka

Europejska Sieć Białaczkowa (ELN) opracowała system klasyfikacji ryzyka genetycznego, który jest powszechnie stosowany do stratyfikacji pacjentów:320

  • Młodsi pacjenci z korzystnym ryzykiem genetycznym ELN (np. CBF) mogą być leczeni samą chemioterapią, z wskaźnikiem wyleczenia około 50-60%
  • Dla pacjentów z pośrednim lub niekorzystnym ryzykiem cytogenetycznym/molekularnym ELN, allogeniczny przeszczep krwiotwórczych komórek macierzystych (alloHSCT) może dawać większe szanse na długoterminowe przeżycie

Nowsze podejścia do stratyfikacji ryzyka integrują ocenę minimalnej choroby resztkowej (MRD):21

  • Pacjenci MRD-pozytywni mogą być skierowani na badania kliniczne mające na celu osiągnięcie negatywności MRD, a ostatecznie alloHSCT
  • Dla osób z określonymi markerami molekularnymi, wysokoczułe ilościowe testy RT-PCR są odpowiednią alternatywą dla cytometrii przepływowej w monitorowaniu MRD

Eksperymentalne modele prognostyczne

Badania nad nowymi modelami prognostycznymi obejmują:2223

  • Skalę prognostyczną opartą na wrażliwości komórek na leki chemioterapeutyczne, ekspresji mRNA MDR1, pochodzeniu guza, niekorzystnych zmianach cytogenetycznych i nieprawidłowym immunofenotypie
  • Przeżycie pacjentów w grupie niskiego ryzyka według tej skali wynosiło 58% (przeżycie 6-miesięczne i 1-roczne) i 46% (przeżycie 3-letnie) ze średnim czasem przeżycia 452 dni
  • Analiza regresji proporcjonalnego hazardu Coxa wykazała, że stratyfikacja ryzyka według tej skali prognostycznej jest niezależnym czynnikiem predykcyjnym przeżycia całkowitego

Obiecujące wyniki badań klinicznych

Ostatnie badania kliniczne przedstawiają obiecujące wyniki, które mogą wpłynąć na przyszłe rokowanie w AML:2425

Przykładem jest badanie fazy 1 SENTI-202 dla nawrotowych/opornych nowotworów hematologicznych, w tym AML:242526

  • 57% wskaźnik całkowitej remisji (4 z 7 pacjentów)
  • Wszyscy 4 pacjenci z całkowitą remisją osiągnęli negatywną minimalną chorobę resztkową (MRD-)
  • Trwałość odpowiedzi w zakresie od 4+ do 8+ miesięcy
  • 3 pacjentów przeszło przeszczep szpiku kostnego po leczeniu SENTI-202
  • Korzystny profil bezpieczeństwa bez toksyczności ograniczającej dawkę

Takie wyniki z badań wczesnej fazy podkreślają potencjał nowych terapii w poprawie rokowania w AML, szczególnie u pacjentów z nawrotową/oporną chorobą.2527

Analiza globalnego obciążenia AML wskazuje na zmieniające się trendy w zachorowalności i śmiertelności:2829

  • Globalne obciążenie AML wzrosło w ciągu ostatnich 32 lat, z rosnącą zachorowalnością i śmiertelnością
  • Zachorowalność na AML jest wyższa u osób starszych i u mężczyzn
  • Spadające standaryzowane względem wieku wskaźniki umieralności (ASDR) sugerują poprawę w leczeniu i zarządzaniu pacjentami z AML
  • Obecnie skuteczność terapeutyczna jest ograniczona, z odsetkiem wyleczeń wynoszącym około 35-45% u pacjentów poniżej 60 roku życia, a u pacjentów powyżej 60 roku życia wskaźnik wyleczeń spada do mniej niż 15%

Zidentyfikowano również kluczowe czynniki ryzyka zgonu związanego z AML:30

  • Wysoki wskaźnik masy ciała (BMI)
  • Narażenie zawodowe na benzen i formaldehyd
  • Palenie tytoniu

Podsumowanie rokowania w AML

Rokowanie w AML jest wysoce zindywidualizowane i zależy od kombinacji wielu czynników:3132

  • Ogólnie 50-80% pacjentów z AML osiąga całkowitą remisję po leczeniu, szczególnie dzieci i osoby poniżej 60 roku życia
  • Około 50% pacjentów, którzy osiągają całkowitą remisję, doświadcza nawrotu AML
  • Pięcioletni wskaźnik przeżycia dla dzieci poniżej 15 roku życia wynosi około 67%
  • Dla dzieci z podtypem APL, pięcioletni wskaźnik przeżycia może przekraczać 80%
  • Generalnie, około 30% dorosłych z AML żyje pięć lat po diagnozie

Warto podkreślić, że statystyki dotyczące przeżycia odzwierciedlają doświadczenia dużych grup pacjentów z AML i nie mogą dokładnie przewidzieć indywidualnego rokowania. Najnowsze postępy w leczeniu AML prawdopodobnie poprawiają rokowanie w porównaniu do historycznych danych.23334

Obecnie, allogeniczny przeszczep komórek macierzystych jest jedynym sposobem całkowitego wyleczenia AML. W zależności od sytuacji, lekarz może zalecić przeszczep komórek macierzystych jako pierwsze leczenie AML lub jeśli AML nawraca w ciągu 12 miesięcy.31

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  1. 11.04.2026
  2. www.leksykon.com.pl

Materiały źródłowe

  • #1 Prognosis and survival for acute myeloid leukemia | Canadian Cancer Society
    https://cancer.ca/en/cancer-information/cancer-types/acute-myeloid-leukemia-aml/prognosis-and-survival
    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. […] The following are prognostic and predictive factors for acute myeloid leukemia (AML). […] 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. […] AML that develops after treatment for another cancer usually has a less favourable prognosis.
  • #2 Acute Myeloid Leukemia (AML): Your Chances for Recovery (Prognosis) | Saint Luke’s Health System
    https://www.saintlukeskc.org/health-library/acute-myeloid-leukemia-aml-your-chances-recovery-prognosis
    Prognosis is the word your healthcare team may use to describe your likely outcome from your leukemia and its treatment. […] A doctor who is most familiar with your health is in the best position to discuss your prognosis with you and explain what the statistics may mean in your case. […] If your AML is likely to respond well to treatment, your doctor will say you have a favorable prognosis. If your leukemia is likely to be hard to control, your prognosis may be less favorable. […] It is not a prediction of what will definitely happen. No doctor can be fully certain about an outcome. […] The relative 5-year survival rate for people diagnosed with AML is 27%. […] So the prognosis for people diagnosed with AML today is likely better. […] It’s important to remember: You are not a statistic.
  • #3 Acute Myeloid Leukemia: Biologic, Prognostic, and Therapeutic Insights
    https://www.cancernetwork.com/view/acute-myeloid-leukemia-biologic-prognostic-and-therapeutic-insights
    Acute myeloid leukemia (AML) is a biologically complex and molecularly and clinically heterogeneous disease, and its incidence is increasing as the population ages. Unfortunately, currently used one-size-fits-all chemotherapy regimens result in cure for only a minority of patients. […] In general, patients with therapy-associated AML and secondary AML have worse outcomes than those with primary (de novo) AML. […] The mainstream approach to defining prognostic risk in AML patients is to conduct cytogenetic and molecular analyses at diagnosis. Generally, patients with recurrent cytogenetic aberrations (~45%) have been grouped into favorable-, intermediate-, and poor-risk categories. […] Cytogenetics alone cannot accurately predict outcome for any of these prognostic groups. However, burgeoning technological developments have recently allowed for extended assessment of molecular biomarkers useful for outcome prediction; these new biomarkers include gene mutations, gene and noncoding RNA expression signatures, and DNA methylation profiles associated with distinct cytogenetic groups.
  • #4 Acute Myeloid Leukemia – StatPearls – NCBI Bookshelf
    https://www.ncbi.nlm.nih.gov/books/NBK507875/
    Prognosis in AML depends on an individual patient’s cytogenetic and molecular characterization. A favorable-risk AML, for instance, can be diagnosed in the presence of translocation of specific chromosomal material, including t(8;21), t(15;17), and inversion of chromosome 16, or t(16;16). Higher-risk cytogenetic aberrancies or mutations, such as t(6;9)(p23.3;q34.1) or mutations in ASXL1 and U2AF1, generate a higher risk and indicate a less favorable prognosis. Adverse outcomes have been noted with older age, WBC count (100,000 at diagnosis), secondary or therapy-related AML, and the presence of leukemic cells in the central nervous system. […] Recent techniques, including PCR and flow cytometry, can detect the presence of minimal residual disease in patients with complete remission. Persistently elevated levels of RUNX1-RUNX1T1, despite induction therapy, in patients with t(8;21) AML are associated with an increased incidence of relapse.
  • #5 Acute myeloid leukemia – Wikipedia
    https://en.wikipedia.org/wiki/Acute_myeloid_leukemia
    Secondary AML has a worse prognosis, as does treatment-related AML arising after chemotherapy for another previous malignancy. Both of these entities are associated with a high rate of unfavorable genetic mutations. […] Different genetic mutations are associated with a difference in outcomes. Certain cytogenetic abnormalities are associated with very good outcomes (for example, the (15;17) translocation in APL). About half of people with AML have „normal” cytogenetics; they fall into an intermediate risk group. A number of other cytogenetic abnormalities are known to associate with a poor prognosis and a high risk of relapse after treatment. […] Elevated lactate dehydrogenase level were also associated with poorer outcomes. Use of tobacco is associated with a person having a poorer prognosis, and people who are married and live together have a better prognosis. People who are treated at place with a higher volume of AML have a better prognosis than those who are treated at those in the lowest quartile.
  • #6 Acute Myeloid Leukemia: Biologic, Prognostic, and Therapeutic Insights
    https://www.cancernetwork.com/view/acute-myeloid-leukemia-biologic-prognostic-and-therapeutic-insights
    The prognostic significance of FLT3 TKD mutations (seen in ~7% of AML) is unknown, although a recent large study has shown a potentially favorable prognostic effect. […] A significant prognostic interaction has been reported between the NPM1 mutation and FLT3-ITD. […] In older CN-AML patients treated with intensive induction chemotherapy, NPM1 mutations predict for excellent disease response and better survival. […] CEBPA mutations occur in 10% to 15% of patients with CN-AML, and it is accepted now that only patients with CEBPA mutations that are biallelic (ie, each allele carries mutations) have a favorable prognosis. […] RUNX1 mutations have been associated with lower complete remission (CR) rates and shorter median disease-free survival (DFS) and overall survival (OS). […] In AML, TP53 mutations are often associated with CK-AML and are correlated with worse outcomes.
  • #7 Prognosis and survival for acute myeloid leukemia | Canadian Cancer Society
    https://cancer.ca/en/cancer-information/cancer-types/acute-myeloid-leukemia-aml/prognosis-and-survival
    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. […] 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. […] An early relapse is also linked with a less favourable prognosis. […] Younger adults, usually those younger than 60 years of age, have a more favourable prognosis than older adults. […] A white blood cell (WBC) count of more than 100,000 cells/mm 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.
  • #8 Survival for acute myeloid leukaemia (AML) | Cancer Research UK
    https://www.cancerresearchuk.org/about-cancer/acute-myeloid-leukaemia-aml/survival
    Survival depends on many factors. No one can tell you exactly how long you will live. […] Your doctor can give you more information about your own outlook (prognosis). […] Generally for all people with AML: more than 15 out of 100 people (more than 15%) will survive their leukaemia for 5 years or more after being diagnosed. […] Younger people tend to do better than older people. […] For those younger than 40: almost 60 out of 100 (almost 60%) will survive their leukaemia for 5 years or more after diagnosis. […] For those aged between 40 and 49: almost 55 out of 100 (almost 55%) will survive their leukaemia for 5 years or more after diagnosis. […] For those aged between 50 and 59: around 35 out of 100 (around 35%) will survive their leukaemia for 5 years or more after diagnosis.
  • #9 Survival for acute myeloid leukaemia (AML) | Cancer Research UK
    https://www.cancerresearchuk.org/about-cancer/acute-myeloid-leukaemia-aml/survival
    For those aged between 60 and 69: more than 15 out of 100 (more than 15%) will survive their leukaemia for 5 years or more after diagnosis. […] For those aged between 70 and 79: around 5 out of 100 (around 5%) will survive their leukaemia for 5 years or more after diagnosis. […] For those aged 80 and over: only 1 out of 100 (only 1%) will survive their leukaemia for 5 years or more after diagnosis. […] Several factors can affect your outlook (prognosis). These are called prognostic factors. […] Your age affects outlook. Younger people have a better prognosis. […] Survival is also affected by how advanced the leukaemia is at diagnosis. If you have a high number of white blood cells in the blood at diagnosis, the outlook is poorer. […] The outcome depends on whether you had leukaemia that changed (transformed) from a chronic form into an acute form. […] Your outlook is affected by how well the leukaemia responds to treatment and how long it takes to get a remission. […] If AML comes back after initial treatment it is called relapsed leukaemia.
  • #10 Survival statistics for acute myeloid leukemia | Canadian Cancer Society
    https://cancer.ca/en/cancer-information/cancer-types/acute-myeloid-leukemia-aml/prognosis-and-survival/survival-statistics
    Survival statistics for acute myeloid leukemia (AML) are very general estimates and must be interpreted very carefully. Because these statistics are based on the experience of groups of people, they cannot be used to predict a particular persons chances of survival. […] In Canada, the 5-year net survival for AML is 23%. This means that, on average, about 23% of people diagnosed with AML will live for at least 5 years. […] The net survival for AML varies by age group. […] Only a doctor familiar with these factors can put all of this information together with survival statistics to arrive at a prognosis.
  • #11 Time from diagnosis to treatment initiation predicts survival in younger, but not older, acute myeloid leukemia patients
    https://pmc.ncbi.nlm.nih.gov/articles/PMC2614639/
    Acute myeloid leukemia (AML) is considered an oncologic emergency. […] We examined the effect of time from AML diagnosis to treatment (TDT) on complete remission (CR) and overall survival (OS), using patient characteristics available at diagnosis. […] CR rate was 67% and median OS was 68 weeks in patients younger than 60 years; 55% and 33 weeks in older patients, respectively. […] In univariate and multivariate analyses, longer TDT was associated with worse CR and OS in younger (univariate: P .001 in both; multivariate: P .001 and P = .001, respectively), but not older patients (univariate: P = .45, P = .19; multivariate: P = .63, P = .30, respectively). […] AML therapy should be initiated immediately in younger patients. […] Delaying treatment does not seem harmful in older patients, allowing individualized approaches.
  • #12 Predicting Treatment Outcomes in Older Patients With Acute Myelogenous Leukemia – Hematology & Oncology
    https://www.hematologyandoncology.net/archives/october-2013/predicting-treatment-outcomes-in-older-patients-with-acute-myelogenous-leukemia/
    H&O Why is there uncertainty regarding treatment options for older adults with acute myelogenous leukemia (AML)? […] HK AML provides one of the most dramatic examples of age-related outcome disparity in oncology, owing to the morbidity of the disease and the intensity of treatment. Older adults represent more than half of all new cases of AML and experience significantly inferior outcomes than younger patients, with higher rates of treatment-associated toxicity and lower overall survival. […] HK The primary outcome of the study was overall survival. After adjusting for clinical and biological factors known to be associated with survival in older AML patients, we found that impairment in both objectively-measured physical performance and cognition were independently associated with worse survival among these patients.
  • #13 Acute myeloid leukemia – Wikipedia
    https://en.wikipedia.org/wiki/Acute_myeloid_leukemia
    For people in remission after induction chemotherapy, residual leukemic cells (minimal residual disease) are associated with higher relapse rates and decreased survival. Furthermore, the presence of specific leukemic cells that are capable of initiating a relapse, the leukemia stem cell (a type of cancer stem cell) is associated with impaired survival and higher incidence of relapse.
  • #14 Time from diagnosis to treatment initiation predicts survival in younger, but not older, acute myeloid leukemia patients
    https://pmc.ncbi.nlm.nih.gov/articles/PMC2614639/
    In this study, we examine, after accounting for other covariates readily available to clinicians at the time of diagnosis, the effect of time from AML diagnosis to treatment (TDT) on CR rates and overall survival (OS) in more than 1300 AML patients from 2 institutions. […] In both univariate and multivariate analyses, longer TDT was associated with worse CR rates and OS in younger (P .001 in all cases), but not older (P .45 for CR and .19 for OS), patients. […] Notably, in younger adults, CR rates and OS appeared to decrease more dramatically with a TDT of 5 or more days. […] Adjusting for cytogenetics and PS, treatment delay was still seen to be an independent prognostic factor for poor outcome (CR and OS) in patients younger than 60 years (P = .003 and P = .009, respectively) and was not associated with outcome in older patients (P = .49 and .94, respectively).
  • #15 Insurance Status and Other Non-biological Factors Predict Outcomes in Acute Myelogenous Leukemia: Analysis of Data from the National Cancer Database | Anticancer Research
    https://ar.iiarjournals.org/content/36/9/4915
    Background: The treatment of acute myeloid leukemia (AML) has made significant progress in the last 30 years; however, numerous factors affect outcomes in patients with AML. […] In multivariate analysis, after adjusting for other predictor variables, payer status was a statistically significant predictor of overall survival for AML. […] The percentage of patients surviving from AML after 24 months was 37.6%, 31.4%, 32.3%, 31.8%, and 33.1% for patients with private, unknown, Medicare, uninsured, and Medicaid payer status, respectively. […] We observed that payer status has a statistically significant relationship with overall survival from AML. […] Payer status has a significant effect on the overall survival of patients with AML after adjusting for all other predictive factors. […] The important comparison is between uninsured, Medicaid, and privately insured patients. Uninsured patients had worse outcomes compared to Medicaid patients, who had worse outcome compared to private insurance.
  • #16
    https://journals.lww.com/md-journal/fulltext/2019/05240/prognostic_nomogram_for_adult_patients_with_acute.54.aspx
    Acute myeloid leukemia (AML) is hematopoietic malignancy. This study was designed to develop an individualized prognostic nomogram to predict cancer-specific survival (CSS) and overall survival (OS) of AML. […] The individualized prognostic nomogram could perform relatively accurate prediction of outcome in adult patients with AML. […] The C-indexes of the nomograms in internal validation for CSS and OS were 0.712 and 0.703, respectively, whereas the C-indexes in external validation for CSS and OS were 0.712 and 0.705, respectively. […] The area under the curve of receiver operating characteristic curves for CSS and OS were 0.799 (95% confidence interval: 0.7920.806) and 0.809 (95% confidence interval: 0.8030.816), respectively. […] The nomogram model, compared with other predictive models, integrated different clinical variables to offer a more accurate and personalized prognosis assessment system. […] Overall, in this study, the bootstrap-corrected and ROC curve-validated nomogram models could perform comparatively accurate prediction of 1, 3, and 5-year survival probabilities, which were clinically practical and relatively reliable in adult patients with AML.
  • #17 Prediction model establishment of prognosis factors for acute myeloid leukemia based on the SEER database | Scientific Reports
    https://www.nature.com/articles/s41598-025-85310-w
    Acute myeloid leukemia (AML) with t(9;11)(p22;q23) presents as a varied hematological malignancy. […] This research aimed to develop a nomogram for precise prediction of overall survival (OS) and cancer-specific survival (CSS) in AML with the t(9;11)(p22;q23) translocation. […] Prognostic factors for this AML subtype were determined using least absolute shrinkage and selection operator (LASSO) regression, which guided the creation of prognostic nomograms. […] Patients were classified into high-risk and low-risk groups based on nomogram scores, with significant differences in OS and CSS between these groups (P<0.001). [...] This study developed innovative nomograms that combine clinical and treatment factors to predict 1-, 3-, and 5-year survival rates for patients with t(9;11)(p22;q23) AML.
  • #18 Prediction model establishment of prognosis factors for acute myeloid leukemia based on the SEER database | Scientific Reports
    https://www.nature.com/articles/s41598-025-85310-w
    In patients under 60 years with t(9;11)(p22;q23)/KMT2A-MLLT3, classified as intermediate risk by the 2017 European Leukemia Net guidelines, outcomes are generally better compared to intermediate-risk patients without this translocation. […] However, older patients with t(9;11) and those with other 11q23/KMT2A rearrangements experience worse outcome. […] Prior research has highlighted diverse clinical characteristics and prognostic factors, including age, sex, race, marital status, and chemotherapy utilization, which impact the prognosis of individuals with t(9;11)(p22;q23) AML. […] The nomogram was developed using key variables including age, race, first primary tumor, and chemotherapy. […] In the training group, the C-index values for the OS and CSS nomograms were 0.704 and 0.686, respectively.
  • #19 Integrated transcriptomic and genomic analysis improves prediction of complete remission and survival in elderly patients with acute myeloid leukemia | Blood Cancer Journal
    https://www.nature.com/articles/s41408-020-0332-3
    Relevant molecular tools for treatment stratification of patients 65 years with acute myeloid leukemia (AML) are lacking. […] We defined a high-risk group with a CR rate of 20% in patients with mutated TP53, compared to 97% CR in low-risk patients defined by high expression of ZBTB7A and EEPD1 without TP53 mutations. […] The results suggest that an integrated molecular risk stratification can improve prediction of CR and OS and could be used to guide treatment in elderly AML patients. […] Prognosis was overall poor in the cohort with a median OS of 8.2 months. […] In the era of hypomethylating agents, the role of achieving CR has been discussed but the remarkably large difference observed in this study highlights the importance of achieving CR when possible in the setting of intensive chemotherapy treatment.
  • #20 Acute Myeloid Leukemia: Biologic, Prognostic, and Therapeutic Insights
    https://www.cancernetwork.com/view/acute-myeloid-leukemia-biologic-prognostic-and-therapeutic-insights
    Approximately 60% of these mutations are identified as missense mutations at codon R882, whereas the remaining are nonsense or frameshift mutations that result in premature truncation of the protein; the latter mutations have been found across different domains of the gene. […] The predictive effect of DNMT3A mutations with regard to the therapeutic response has also been evaluated. […] The prognostic impact of WT1 mutations in patients with AML is not universally agreed upon, but most studies report an inferior outcome. […] In older patients, outcomes are generally poorer than in younger patients, likely due to the increased frequency of negative clinical, cytogenetic, and molecular prognosticators in older patients, and because of greater treatment-related morbidity and mortality. […] Younger patients (see Figure 1) with a favorable ELN genetic risk (eg, CBF) can be treated with chemotherapy alone, with a cure rate of ~50% to 60%; the most appropriate dose and number of consolidation chemotherapy cycles remain to be determined.
  • #21 Acute Myeloid Leukemia: Biologic, Prognostic, and Therapeutic Insights
    https://www.cancernetwork.com/view/acute-myeloid-leukemia-biologic-prognostic-and-therapeutic-insights
    For patients with intermediate or adverse cytogenetic/molecular ELN risk, alloHSCT may confer relatively greater chances of long-term survival. […] Patients positive for MRD, who would otherwise be destined to receive chemotherapy only, may be switched to treatment studies designed to achieve MRD negativity, and may eventually receive alloHSCT. […] For individuals with specific molecular markers, highly sensitive quantitative real-time reverse transcription polymerase chain reaction (RT-PCR) based assays are a suitable alternative to flow cytometry. […] The challenge is how to match molecular and clinical information with emerging compounds in order to select the best treatment for individual patients.
  • #22 Effective Prognostic Model for Therapy Response Prediction in Acute Myeloid Leukemia Patients
    https://www.mdpi.com/2075-4426/13/8/1234
    Effective Prognostic Model for Therapy Response Prediction in Acute Myeloid Leukemia Patients […] Acute myeloid leukemia (AML) is a hematopoietic disorder characterized by the malignant transformation and abnormal proliferation of bone marrow-derived myeloid progenitors. […] Despite this contemporary approach, tumor cell resistance to chemotherapeutic drugs represents one of the main obstacles for improving survival outcomes in AML. […] Using correlation, ROC, and Cox regression analyses, we demonstrated that the risk stratification of AML patients in accordance with the developed prognostic scale correlates well with the response to therapy and represents an independent predictive factor for the overall survival of patients with newly diagnosed AML. […] The goal of AML treatment should be the eradication of the disease, whenever possible, accomplished by inducing complete remission (CR) with initial therapy. […] However, the response to treatment and the overall prognosis in a particular patient are variable, dependent on the several patient- and tumor-specific factors mentioned above. […] Despite significant advances in improving the outcomes of hematological disorders over the past decades, mostly due to the development of targeted therapeutics, AML patients respond differently to treatment and prognosis.
  • #23 Effective Prognostic Model for Therapy Response Prediction in Acute Myeloid Leukemia Patients
    https://www.mdpi.com/2075-4426/13/8/1234
    It is known that induction failure due to resistance to chemotherapeutic agents represents a serious obstacle for improving survival outcomes in AML. […] The present study evaluated the contribution of tumor cell drug responsiveness to predict the therapy response and overall survival of patients with AML. […] Our study demonstrates that the developed prognostic scale for the risk stratification of AML patients based on cell sensitivity to chemotherapeutic drugs, MDR1 mRNA expression, tumor origin (primary or secondary), unfavorable cytogenetic abnormalities, and aberrant immunophenotype is related to the therapy response and represents an independent predictive factor for the overall survival of newly diagnosed AML patients without complicated clinical and hematological anamnesis. […] The overall survival of patients in the low-risk group was 58% (6-month and 1-year survival) and 46% (3-year survival) with a medium survival rate of 452 days. […] Thus, the survival of patients assigned to the low-risk group was quite higher than that of patients assigned to the high- and intermediate-risk groups according to our prognostic scale, which indicates the reliability and robustness of our classification. […] Thus, univariate and multivariate Cox proportional hazards regression analyses clearly demonstrate that the risk stratification according to the prognostic scale introduced in this work is an independent predictive factor for the overall survival of primary AML patients without complicated clinical and hematological anamnesis, severe comorbidities, and previous treatment.
  • #24 Senti Bio Reports First Quarter 2025 Financial Results and
    https://www.globenewswire.com/news-release/2025/05/06/3075602/0/en/Senti-Bio-Reports-First-Quarter-2025-Financial-Results-and-Provides-a-Corporate-Update-on-Positive-SENTI-202-Clinical-Development.html
    We continue to be encouraged by our SENTI-202 data and strongly believe in its potential to provide a much-needed treatment option for patients with AML. […] Notably, our recent data at AACR showed early deep responses seen with SENTI-202 across dose levels, with 4+ to 8+ months of durability noted and growing. […] New Positive Data for Lead Program SENTI-202 Drives Confidence as a Potential Treatment Option for Acute Myeloid Leukemia (AML): The Company presented positive data from its ongoing Phase 1 clinical trial of SENTI-202 (NCT06325748) for the treatment of relapsed/refractory hematologic malignancies including AML at the recently held American Association for Cancer Research (AACR) Annual Meeting 2025. […] As previously announced, SENTI-202 was well-tolerated with no dose limiting toxicities and a maximum tolerated dose was not reached. […] 4 of 4 cCR patients were MRD- (Measurable Residual Disease Negative) as assessed by local standard of care. All cCR patients continue in remission with follow-ups ranging from 4+ to 8+ months ongoing, and 3 patients received a bone marrow transplant after treatment with SENTI-202.
  • #25 Senti Bio Phase 1 Trial Shows 57% Complete Remission Rate in AML Treatment | SNTI Stock News
    https://www.stocktitan.net/news/SNTI/senti-bio-reports-first-quarter-2025-financial-results-and-provides-tufn1j2s0i0v.html
    Senti’s SENTI-202 shows promising early efficacy in AML with 4/7 patients achieving complete remission and MRD negativity with 4-8+ months durability. […] The Phase 1 results for SENTI-202 in relapsed/refractory AML represent a potentially significant development. The 57% complete remission rate (4 of 7 patients) is noteworthy for this difficult-to-treat population. Even more impressive is that all 4 responders achieved MRD negativity as assessed by local standard of care, which correlates with better long-term outcomes in AML. […] The durability of responses ranging from 4+ to 8+ months ongoing is particularly encouraging. For context, many patients with relapsed/refractory AML typically progress within months of treatment. The fact that 3 patients proceeded to bone marrow transplant after SENTI-202 suggests it may serve as an effective bridge to potentially curative therapy – a valuable clinical pathway.
  • #26 Senti Bio Phase 1 Trial Shows 57% Complete Remission Rate in AML Treatment | SNTI Stock News
    https://www.stocktitan.net/news/SNTI/senti-bio-reports-first-quarter-2025-financial-results-and-provides-tufn1j2s0i0v.html
    The identification of a preliminary recommended Phase 2 dose of 1.5 x 10^9 CAR NK cells administered on Days 0, 7, 14 in 28-day cycles following lymphodepletion represents an important milestone. The favorable safety profile with no dose-limiting toxicities is notable for a cell therapy, as many similar approaches often encounter significant toxicity challenges. […] While these results are promising, it’s important to recognize the small patient sample and early nature of the data. However, the combination of response rate, MRD negativity, and durability in this difficult disease setting certainly warrants continued development and close attention. […] Positive Phase 1 data from lead program, SENTI-202, recently presented at the AACR Annual Meeting: SENTI-202 was generally well tolerated, preliminary RP2D identified; 4 of 7 patients achieved composite Complete Remission (cCR) (3 CR, 1CRh), all 4 cCR patients were measurable residual disease (MRD) negative as assessed by local standard of care; All cCR patients maintaining responses, from 4+ to 8+ months ongoing.
  • #27 Senti Bio Phase 1 Trial Shows 57% Complete Remission Rate in AML Treatment | SNTI Stock News
    https://www.stocktitan.net/news/SNTI/senti-bio-reports-first-quarter-2025-financial-results-and-provides-tufn1j2s0i0v.html
    New Positive Data for Lead Program SENTI-202 Drives Confidence as a Potential Treatment Option for Acute Myeloid Leukemia (AML): The Company presented positive data from its ongoing Phase 1 clinical trial of SENTI-202 for the treatment of relapsed/refractory hematologic malignancies including AML. […] As previously announced, SENTI-202 was well-tolerated with no dose limiting toxicities and a maximum tolerated dose was not reached. The preliminary recommended Phase 2 dose (RP2D) was identified based on the totality of clinical data, including efficacy, as 1.5 x 10^9 CAR NK cells administered on Days 0,7,14 in 28-day Cycles following lymphodepleting chemotherapy. […] 4 of 4 cCR patients were MRD- (Measurable Residual Disease Negative) as assessed by local standard of care. All cCR patients continue in remission with follow-ups ranging from 4+ to 8+ months ongoing, and 3 patients received a bone marrow transplant after treatment with SENTI-202.
  • #28 Global, regional, and national burden of acute myeloid leukemia, 1990–2021: a systematic analysis for the global burden of disease study 2021 | Biomarker Research | Full Text
    https://biomarkerres.biomedcentral.com/articles/10.1186/s40364-024-00649-y
    Acute myeloid leukemia (AML), as the most common subtype of leukemia in adults, is characterised by rapid progression and poor prognosis. […] The global burden of AML has increased over the past 32 years, with rising morbidity and mortality. […] The incidence of AML is differentially distributed across different SDI countries or regions. […] AML incidence is higher in the elderly and in men. […] The findings highlight the need for region-specific prevention and call for future research on preventive strategies and new treatments to lower AML incidence and improve patient outcomes. […] The rise in fatalities may be associated with the growing number of cases, but the declining ASDR suggested that there may have been improvements in the medical treatment and management of AML patients.
  • #29 Global, regional, and national burden of acute myeloid leukemia, 1990–2021: a systematic analysis for the global burden of disease study 2021 | Biomarker Research | Full Text
    https://biomarkerres.biomedcentral.com/articles/10.1186/s40364-024-00649-y
    The increase in ASIR in middle and low SDI quintile may be related to lifestyle, genetic factors, and environmental factors. […] The occurrence and death rates of AML globally show intricate patterns, influenced by various factors such as population demographics, economic advancement, and healthcare quality. […] Our findings indicate that across all geographical regions, there is a concomitant increase in the incidence rate, death, and DALYs for AML with growing age. […] Current AML treatment guidelines recommend the high-dose cytarabine consolidation chemotherapy or allogeneic stem cell transplantation (Allo-HSCT) based on the individuals disease risk profile to mitigate the risk of relapse. […] However, the efficacy of this therapeutic approach is limited, with a curative rate ranging from approximately 35-45% in patients under 60, while in those over 60, the cure rate diminishes to less than 15%.
  • #30 Global, regional, and national burden of acute myeloid leukemia, 1990–2021: a systematic analysis for the global burden of disease study 2021 | Biomarker Research | Full Text
    https://biomarkerres.biomedcentral.com/articles/10.1186/s40364-024-00649-y
    Our study also investigated potential risk factors for AML-related death. […] High body mass index (BMI), occupational exposure to benzene, formaldehyde, and smoking are key factors in the occurrence of AML. […] In conclusion, high BMI, occupational exposure to formaldehyde and benzene, and smoking are pivotal risk factors for the incidence and mortality of AML. […] These findings underscore the importance of developing preventive measures tailored to different regions and populations. Future research should focus on developing effective prevention strategies and exploring novel therapeutic approaches to reduce the incidence of AML and improve patient prognosis.
  • #31 Acute Myeloid Leukemia (AML): Symptoms, Treatment & Prognosis
    https://my.clevelandclinic.org/health/diseases/6212-acute-myeloid-leukemia-aml
    Currently, allogeneic stem cell transplantation is the only way to cure acute myeloid leukemia. Depending on your situation, your provider may recommend stem cell transplantation as your first AML treatment or if you have AML that comes back within 12 months. Unfortunately, not everyone may be a candidate for stem cell transplantation. […] There are two sides of the coin in acute myeloid leukemia prognoses. One side is complete remission. The other is recurrence, when AML comes back: Overall, an estimated 50% to 80% of people with acute myeloid leukemia achieve complete remission after treatment. Complete remission happens more often in children and people under age 60. Remission may last for months or years. About 50% of people who achieve complete remission develop recurrent AML. When that happens, providers may recommend additional chemotherapy or stem cell transplantation. They may suggest participation in a clinical trial.
  • #32 Acute Myeloid Leukemia (AML): Symptoms, Treatment & Prognosis
    https://my.clevelandclinic.org/health/diseases/6212-acute-myeloid-leukemia-aml
    Acute myeloid leukemia is a complicated illness. There are several AML subtypes, which makes it difficult to be specific about survival rates. For example, the five-year survival rate for children under age 15 is 67%. But some research suggests that five-year survival rate increases to more than 80% in children who have the APL subtype. And age makes a difference. In general, 30% of adults with acute myeloid leukemia are alive five years after diagnosis. Remember, AML typically affects people age 60 and older who may have other health issues. […] It’s important to remember that survival rates reflect the experiences of large groups of people with AML. In this case, survival rate data includes survival rates from 2012 to 2018, and there are some new and more effective treatments for AML. Many things affect how long you’ll live with acute myeloid leukemia. That means your healthcare providers, the people who know your medical history and your overall health, are your best resources for information.
  • #33 How Long Will I Live with Acute Myeloid Leukemia? – HealthTree for Acute Myeloid Leukemia
    https://healthtree.org/aml/community/how-long-will-i-live-with-acute-myeloid-leukemia
    Acute myeloid leukemia (AML) is a complex disease with a variable prognosis. The life expectancy for someone with AML can depend on many factors, including the patient’s age, overall health, the subtype of AML, and the specific genetic mutations present in the leukemia cells. It’s important to note that while statistics can provide a general idea about most people’s experiences, they can’t predict any individual’s specific outcome. […] The higher the survival rate, the more favorable the outcome. According to the American Cancer Society, the 5-year survival rate for people under the age of 60 diagnosed with AML is around 30-40%. For people over the age of 60, the 5-year survival rate drops to less than 20%. However, these statistics are averages and the survival rate can vary widely depending on specific factors related to the patient and the disease.
  • #34 How Long Will I Live with Acute Myeloid Leukemia? – HealthTree for Acute Myeloid Leukemia
    https://healthtree.org/aml/community/how-long-will-i-live-with-acute-myeloid-leukemia
    It’s important to note that survival statistics are general trends and a patient’s individual prognosis can vary greatly. Each patient’s case is unique and should be discussed with their healthcare provider. […] According to data from 2014-2020 the estimated 5 year relative survival is 31.9%. […] AML is a type of blood cancer, unfortunately it is considered a chronic condition. If left untreated, it can be considered life-threatening. […] With treatment, acute myeloid leukemia can be controlled, and the symptoms can be alleviated. Research and participation in clinical trials can improve AML’s survival rate. […] Acute myeloid leukemia (AML) is considered aggressive because the rapid growth of cancer cells which produce various symptoms that may impair a person’s health and life quality.