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    Patent Pending

    Duval/CIBMTR Score for Acute Myelogenous Leukemia (AML) Survival

    Predicts overall survival in AML patients with relapsed/refractory disease undergoing myeloablative transplant.
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    INSTRUCTIONS

    Use in patients with relapsed or refractory active AML for whom hematopoietic stem cell transplant (HSCT) is being considered. Do not use in patients with chronic myelogenous leukemia (CML) in blast crisis.

    When to Use
    Pearls/Pitfalls
    Why Use

    • Patients with relapsed or refractory active acute myeloid leukemia AML (i.e., NOT in complete remission), for whom myeloablative hematopoietic stem cell transplant (HSCT) is being considered.

    • Do not use in patients with chronic myelogenous leukemia (CML) in blast crisis.

    • Only busulfan and TBI-based regimens were studied in the derivation; reduced-intensity conditioning (RIC) and fludarabine-based regimens were excluded.

    • Syngeneic and cord blood transplants were also not included in this analysis.

    Use when deciding between HSCT and additional treatment for patients with relapsed or refractory active disease.

    Primary induction failure or duration of first complete remission >6 months
    0
    Duration of first complete remission <6 months
    +1
    Good or intermediate
    0
    Poor
    +1
    HLA identical sibling or well matched or partially matched unrelated
    0
    Mismatched unrelated
    +1
    Related other than HLA identical sibling
    +2
    Absent
    0
    Present
    +1
    90-100
    0
    <90
    +1

    Result:

    Please fill out required fields.

    Next Steps
    Evidence
    Creator Insights

    Advice

    High-risk patients with 3-year overall survival (OS) of 6% should be counseled and preferably referred for relapse-mitigation clinical trials.

    Management

    HSCT should be considered in patients with scores ≤2 in the context of other available therapies, given their predicted OS of 15-46%.

    Critical Actions

    Risk should be discussed with the patient.

    Formula

    Addition of the selected points:


    Variable

    0 Points

    1 Point

    2 Points

    Disease group

    Primary induction failure or duration of first complete remission >6 months

    Duration of first complete remission <6 months

    --

    Cytogenetics prior to HSCT

    Good or intermediate

    Poor

    --

    HLA match group

    HLA identical sibling or well matched or partially matched unrelated

    Mismatched unrelated

    Related other than HLA identical sibling

    Circulating blasts*

    Absent

    Present

    --

    Karnofsky or Lansky scale

    90-100

    <90

    --

    *At the time of transplant.

    Facts & Figures

    Interpretation:

    Duval Score

    3-year overall survival after transplantation

    0

    42%

    1

    28%

    2

    15%

    ≥3

    6%

    From Duval 2010.

    Evidence Appraisal

    The original study was a retrospective analysis of Center for International Blood and Marrow Transplant Research (CIBMTR) data of 1,673 patients with relapsed or refractory AML from 221 centers. All patients had active disease at the time of transplant. Patient, disease, and HSCT characteristics were examined. Median follow-up was 61 months. Overall survival was examined, given the absence of post-transplant remission in some patients. The variables included in the final score were found to be predictors of overall survival in multivariate analysis. A separate prediction model for acute lymphoblastic leukemia (ALL) was also included.

    This score was validated retrospectively using data from GITMO (Italian Group for Blood and Marrow Transplantation), in Italy including an analysis of patients undergoing RIC or cord blood transplant.

    Literature

    Dr. Michel Duval

    About the Creator

    Michel Duval, MD, is the medical director of the hematopoietic transplantation and Cell Therapy Program at the Charles-Bruneau Cancer Center, at the Sainte-Justine University Hospital Center in Montreal, Canada. He is also the co-chief of the hemato-oncology department at the Centre Hospitalier Universitaire Sainte-Justine. Dr. Duval’s research focuses primarily on immunotherapy of childhood cancers and cord blood transplant immunology.

    To view Dr. Michel Duval's publications, visit PubMed

    Content Contributors
    • Joseph Maakaron, MD
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