Multi-center 11-year experience of intensive versus less-intensive induction therapy for high-risk and vulnerable patients with newly-diagnosed acute myeloid leukemia

Less-intensive induction therapies are increasingly used in older patients with acute myeloid leukemia, assuming they are better than intensive induction. Using an AML-composite model (AML-CM) that assigns higher scores to older age, increased comorbidity-burdens and adverse cytogenetic-risks, we defined three distinct prognostic groups, and within each, compared outcomes after less-intensive versus intensive induction therapies in a multicenter retrospective cohort (n=1292) treated at six institutions from 2008-2012 and a prospective cohort (n=695) treated at thirteen institutions from 2013-2017. Prospective study included impacts of Karnofsky performance status (KPS), quality of life (QOL), and physicians' perceptions of cure. In the retrospective cohort, recipients of less-intensive therapies were older, had more comorbidities, more adverse cytogenetics, and worse KPS. Less-intensive therapies were associated with higher risks for mortality in AML-CM scores of 4-6, 7-9, and ≥10. Results were independent from receipt of allogeneic transplants and similar in those aged 70-79 years old. In the Prospective cohort, the two groups were similar in baseline QOL, geriatric assessment, and patients' outcome preferences. Higher mortality risks were seen after less-intensive therapies. However, in models adjusted for age, physician-assigned KPS and chances of cure, mortality risks and QOL were similar. Less-intensive recipients had lessened length of hospitalization (LOH). Our studies question the survival or QOL, except LOH, benefits from less-intensive therapies in patients with AML, including those aged 70-79 years or with high comorbidity-burden. A randomized trial in older/medically infirm patients is needed to better assess the value of less-intensive, intensive, or a combination of both therapies. #NCT01929408.



Work Title Multi-center 11-year experience of intensive versus less-intensive induction therapy for high-risk and vulnerable patients with newly-diagnosed acute myeloid leukemia
Open Access
  1. Mohamed L. Sorror
  2. Barry E. Storer
  3. A T Fathi
  4. A Brunner
  5. Aaron T Gerds
  6. Mikkael A Sekeres
  7. Sudipto Mukherjee
  8. Bruno C Medeiros
  9. Eunice S Wang
  10. P Vachhani
  11. Paul J Shami
  12. E Pena
  13. M Elsawy
  14. J P Galvin
  15. Kehinde U Adekola
  16. Selina Luger
  17. Maria R Baer
  18. David A Rizzieri
  19. Tanya M Wildes
  20. Stefan Faderl
  21. Jamie L Koprivnikar
  22. Julie Smith
  23. Mitchell Garrison
  24. Kiarash Kojouri
  25. Jennifer E Nyland
  26. Pamela S Becker
  27. J S McCune
  28. Stephanie J Lee
  29. Brenda M Sandmaier
  30. Frederick R Appelbaum
  31. Elihu H Estey
License In Copyright (Rights Reserved)
Work Type Article
  1. Blood
Publication Date May 4, 2021
Publisher Identifier (DOI)
Deposited July 19, 2021




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Work History

Version 1

  • Created
  • Added 1-s2.0-S0006497121009721-main.pdf
  • Added Creator Mohamed L. Sorror
  • Added Creator Barry E. Storer
  • Added Creator A T Fathi
  • Added Creator A Brunner
  • Added Creator Aaron T Gerds
  • Added Creator Mikkael A Sekeres
  • Added Creator Sudipto Mukherjee
  • Added Creator Bruno C Medeiros
  • Added Creator Eunice S Wang
  • Added Creator P Vachhani
  • Added Creator Paul J Shami
  • Added Creator E Pena
  • Added Creator M Elsawy
  • Added Creator J P Galvin
  • Added Creator Kehinde U Adekola
  • Added Creator Selina Luger
  • Added Creator Maria R Baer
  • Added Creator David A Rizzieri
  • Added Creator Tanya M Wildes
  • Added Creator Stefan Faderl
  • Added Creator Jamie L Koprivnikar
  • Added Creator Julie Smith
  • Added Creator Mitchell Garrison
  • Added Creator Kiarash Kojouri
  • Added Creator Jennifer E Nyland
  • Added Creator Pamela S Becker
  • Added Creator J S McCune
  • Added Creator Stephanie J Lee
  • Added Creator Brenda M Sandmaier
  • Added Creator Frederick R Appelbaum
  • Added Creator Elihu H Estey
  • Published
  • Updated
  • Updated