Background
Methods
Study design
Data collection
Statistical analysis
Results
Selection of the study population
Excluded sample (n = 113) | Study sample (n = 592) | Test comparing study sample with excluded sample characteristics | ||||
---|---|---|---|---|---|---|
N |
% or mean (sd)
| N |
% or mean (sd)
| |||
Treatment (total N = 696) | Intensive chemotherapy | 7 |
7
| 187 |
32
|
p* < 0.001
|
Best supporting care | 81 |
12
| 179 |
30
| ||
Hypomethylating agents | 12 |
3
| 175 |
7
| ||
Aracytine low dose | 3 |
78
| 42 |
30
| ||
Others | 1 |
1
| 9 |
1
| ||
Patient’s characteristics | ||||||
Age | Median (inter-quartile range) | 80 |
10
| 74 |
12
| p # < 0.001 |
Sex | Men | 59 |
52
| 364 |
61
| p § = 0.065 |
Women | 54 |
48
| 228 |
39
| ||
Patients’ SEP (EDI quintile) (total N = 613) | Q1 – least deprived | 3 |
14
| 124 |
21
| |
Q2 | 6 |
29
| 104 |
18
| ||
Q3 | 6 |
29
| 127 |
21
|
p * = 0.388
| |
Q4 | 5 |
24
| 137 |
23
| ||
Q5 – most deprived | 1 |
5
| 100 |
17
| ||
Charlson comorbidity index | 0 | 20 |
19
| 261 |
44
| |
1 | 11 |
10
| 122 |
21
| p § = 0.001 | |
2+ | 12 |
11
| 104 |
18
| ||
Undefinable | 64 |
60
| 105 |
18
| ||
Performance status | 0/1 | 26 |
25
| 309 |
52
| |
2 | 13 |
13
| 91 |
15
| p § = 0.001 | |
3/4 | 10 |
10
| 60 |
10
| ||
Undefinable | 55 |
53
| 132 |
22
| ||
Tumor’s characteristics | ||||||
White blood cell counts (tercile) (total N = 599) | Tercile 1 – low | 1 | 14 | 195 | 33 | |
Tercile 2 – intermediate | 4 | 57 | 189 | 32 |
p * = 0.393
| |
Tercile 3 – high | 2 | 29 | 193 | 33 | ||
Undefinable | 0 | 0 | 15 | 3 | ||
AML ontogeny (total N = 704) | AML de novo | 36 | 32 | 301 | 51 | |
Secondary AML (post treatment / MDS) | 41 | 37 | 268 | 45 | p § < 0.001 | |
Undefinable | 35 | 31 | 23 | 4 | ||
Cytogenetic initial prognosis | Favorable/Intermediate | 50 | 44 | 343 | 58 | p § < 0.001 |
Unfavorable | 26 | 23 | 203 | 34 | ||
Undefinable | 37 | 33 | 46 | 8 |
Description of the study population
Patients’ SEP (EDI quintile) | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
0 (least deprived) | 1 | 2 | 3 | 4 (most deprived) | |||||||
n | % | n | % | n | % | n | % | n | % | ||
Sex | Men | 74 |
59.68
| 71 |
68.27
|
70
| 55.12 |
86
| 62.77 | 63 | 63.00 |
Women | 50 | 40.32 | 33 |
31.73
|
57
| 44.88 |
51
| 37.23 | 37 | 37.00 | |
Age (median (interquartile range)) | 74 |
15.5
| 75 |
13.00
|
74
| 11.00 | 73 | 12.00 | 75 | 12.50 | |
Charlson comorbidity index | 0 | 59 | 47.58 |
51
| 49.04 | 54 | 42.52 | 61 | 44.53 | 36 | 36.00 |
1 | 27 | 21.77 | 20 |
19.23
| 21 | 16.54 | 26 | 18.98 | 28 | 28.00 | |
2+ | 19 | 15.32 | 18 |
17.31
| 22 | 17.32 | 30 | 21.90 | 15 | 15.00 | |
Undefinable | 19 | 15.32 |
15
|
14.42
| 30 | 23.62 | 20 | 14.60 | 21 | 21.00 | |
Performance status | 0/1 | 70 | 56.45 | 59 | 56.73 | 67 | 52.76 | 72 | 52.55 | 41 | 41.00 |
2 | 14 | 11.29 | 18 | 17.31 | 15 | 11.81 | 23 | 16.79 | 21 | 21.00 | |
3/4 | 8 | 6.45 | 10 | 9.62 | 15 | 11.81 | 16 | 11.68 | 11 | 11.00 | |
Undefinable | 32 | 25.81 | 17 | 16.35 | 30 | 23.62 | 26 |
18.98
| 27 | 27.00 | |
White blood cell (terticle | Low | 35 | 28.23 | 35 | 33.65 |
37
| 29.13 | 55 | 40.15 | 33 | 33.00 |
Medium | 43 | 34.68 | 36 | 34.62 |
44
| 34.65 | 38 | 27.74 | 28 | 28.00 | |
High | 44 | 35.48 | 33 | 31.73 |
41
| 32.28 | 41 | 29.93 | 34 | 34.00 | |
Undefinable | 2 | 1.61 | 0 | 0.00 |
5
| 3.94 | 3 | 2.19 | 5 | 5.00 | |
AML ontogeny | AML de novo | 74 | 59.68 | 51 | 49.04 | 63 | 49.61 | 73 | 53.28 | 40 | 40.00 |
Secondary AML (post treatment / MDS) | 46 | 37.10 | 49 | 47.12 | 59 | 46.46 | 60 | 43.80 | 54 | 54.00 | |
Undefinable | 4 | 3.23 | 4 | 3.85 | 5 | 3.94 | 4 | 2.92 | 6 | 6.00 | |
Cytogenetic prognosis | Favorable/Intermediate | 77 | 62.10 | 54 | 51.92 | 76 | 59.84 | 84 | 61.31 | 52 | 52.00 |
Unfavorable | 38 | 30.65 | 44 | 42.31 | 39 | 30.71 | 42 | 30.66 | 40 | 40.00 | |
Undefinable | 9 | 7.26 | 6 | 5.77 | 12 | 9.45 | 11 | 8.03 | 8 | 8.00 | |
Treatment | Intensive chemotherapy | 50 | 40.32 | 28 | 26.92 | 42 | 33.07 | 44 | 32.12 | 23 | 23.00 |
Low intensive therapy | 40 | 32.26 | 43 | 41.35 | 45 | 35.43 | 57 | 41.61 | 41 | 41.00 | |
Best supportive care | 34 | 27.42 | 33 | 31.73 | 40 | 31.50 | 36 | 26.28 | 36 | 36.00 |
Influence of SEP on overall survival
Main components | Model 1.0 (M1.0) | Model 1.1 | Model 1.2 | Model 1.3 | Model 1.4 | Model 1.5 | Model 1.6 | M 1.7 | |||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
M1.0 + perf. Status | M1.0 + AML ont | M1.0 + WBC. | M1.0 + cyto. Progn. | M1.0 + treatment | All but treatment | Fully adjusted | |||||||||||||||||
HR | [95% CI] | HR | [95% CI] | HR | [95% CI] | HR | [95% CI] | HR | [95% CI] | HR | [95% CI] | HR | [95% CI] | HR | [95% CI] | ||||||||
Age | 1.04 | [1.03; 1.05] | 1.03 | [1.02; 1.05] | 1.04 | [1.03; 1.05] | 1.04 | [1.03; 1.05] | 1.04 | [1.02; 1.05] | 1.01 | [1.00; 1.03] | 1.03 | [1.02; 1.05] | 1.02 | [1.00; 1.03] | |||||||
Sex | Men | ref | ref | ref | ref | ref | Ref | ref | |||||||||||||||
Women | 0.88 | [0.73; 1.07] | 0.86 | [0.71; 1.04] | 0.87 | [0.72; 1.05] | 0.89 | [0.74; 1.08] | 0.84 | [0.69; 1.01] | 0.87 | [0.72; 1.05] | 0.81 | [0.67; 0.98] | 0.82 | [0.68; 1.00] | |||||||
Patients’ SEP (quintile of deprivation score) | Q1 – least | ref | Ref | Ref | Ref | Ref | ref | Ref | |||||||||||||||
Q2 | 1.14 | [0.85; 1.53] | 1.11 | [0.83; 1.50] | 1.08 | [0.80; 1.45] | 1.17 | [0.87; 1.35] | 1.06 | [0.79; 1.42] | 1 | [0.84; 1.50] | 1.01 | [0.75; 1.37] | 0.96 | [0.71; 1.29] | |||||||
Q3 | 0.89 | [0.67; 1.18] | 0.85 | [0.64; 1.13] | 0.83 | [0.62; 1.11] | 0.88 | [0.66; 1.17] | 0.89 | [0.67; 1.18] | 0.84 | [0.69; 1.22] | 0.80 | [0.60; 1.07] | 0.78 | [0.58; 1.04] | |||||||
Q4 | 1.07 | [0.82; | 1.40] | 1.02 | [0.78; 1.33] | 1.03 | [0.79; 1.35] | 1.07 | [0.82; 1.40] | 1.06 | [0.81; 1.38] | 1 | [0.82; 1.40] | 0.99 | [0.75; 1.30] | 0.94 | [0.71; 1.24] | ||||||
Q5 – most | 1.39 | [1.04; 1.87] | 1.37 | [1.02; 1.84] | 1.31 | [0.97; 1.76] | 1.47 | [1.10; 1.97] | 1.30 | [0.97; 1.75] | 1.35 | [1.12; 2.01] | 1.28 | [0.95; 1.73] | 1.29 | [0.95; 1.74] | |||||||
Charlson comorbidity index | 0 | ref | ref | ref | ref | ref | ref | ref | |||||||||||||||
1 | 1.1 | [0.86; 1.41] | 1.02 | [0.80; 1.31] | 1.08 | [0.85; 1.38] | 1.15 | [0.90; 1.47] | 1.09 | [0.86; 1.40] | 1.01 | [0.79; 1.29] | 1.07 | [0.83; 1.37] | 1.00 | [0.78; 1.28] | |||||||
2+ | 1.29 | [1.01; 1.66] | 1.18 | [0.92; 1.52] | 1.21 | [0.94; 1.56] | 1.3 | [1.01; 1.66] | 1.35 | [1.06; 1.73] | 1.13 | [0.88; 1.45] | 1.19 | [0.92; 1.54] | 1.08 | [0.83; 1.41] | |||||||
Undefined | 2.1 | [1.60; 2.76] | 1.89 | [1.39; 2.56] | 1.88 | [1.40; 2.53] | 2.06 | [1.56; 2.73] | 1.97 | [1.49; 2.61] | 1.29 | [0.96; 1.74] | 1.66 | [1.20; 2.31] | 1.25 | [0.89; 1.75] | |||||||
Performance status | 0/1 | ref | Ref | ref | |||||||||||||||||||
2 | 1.51 | [1.16; 1.97] | 1.49 | [1.15; 1.95] | 1.50 | [1.15; 1.95] | |||||||||||||||||
3/4 | 2.36 | [1.70; 3.28] | 1.90 | [1.34; 2.68] | 1.72 | [1.22; 2.42] | |||||||||||||||||
Undefined | 1.75 | [1.24; 2.48] | 1.52 | [1.04; 2.20] | 1.29 | [0.88; 1.88] | |||||||||||||||||
AML ontogeny | AML de novo | ref | Ref | ref | |||||||||||||||||||
Secondary AML (post treatment / MDS) | 1.25 | [1.03; 1.52] | 1.21 | [0.99; 1.48] | 1.12 | [0.91; 1.38] | |||||||||||||||||
Undefined | 1.56 | [0.90; 2.72] | 1.60 | [0.90; 2.83] | 1.52 | [0.86; 2.70] | |||||||||||||||||
White blood cell (WBC) counts (tercile) | Tercile 1 – low | ref | Ref | ||||||||||||||||||||
Terticle 2 – intermediate | 1.42 | [1.10; 1.83] | 1.38 | [1.06; 1.79] | 1.34 | [1.04; 1.74] | |||||||||||||||||
Terticle 3 – high | 2.24 | [1.66; 3.01] | 2.16 | [1.59; 2.93] | 2.36 | [1.74; 3.20] | |||||||||||||||||
Undefined | 2.9 | [1.50; 5.60] | 2.28 | [1.14; 4.56] | 2.10 | [1.05; 4.21] | |||||||||||||||||
Cytogenetic prognosis | Favorable/Intermediate | ||||||||||||||||||||||
Unfavorable | 2.00 | [1.64; 2.43] | 2.01 | [1.64; 2.46] | 1.72 | [1.38; 2.13] | |||||||||||||||||
Undefinable | 1.99 | [1.34; 2.96] | 1.88 | [1.24; 2.86] | 1.44 | [0.95; 2.18] | |||||||||||||||||
Treatment | Intensive chemotherapy | ref | |||||||||||||||||||||
Low intensive therapy | 1.53 | [1.19; 1.96] | 1.36 | [1.01; 1.82] | |||||||||||||||||||
Best supportive care | 4.11 | [2.93; 5.77] | 3.24 | [2.21; 4.76] | |||||||||||||||||||
Time varying component | |||||||||||||||||||||||
Time * Performance status | 0.9998 [0.9997;0.9999] | 0.9999 [0.9998; 1.0000] | 0.9999 [0.9998; 1.0000] | ||||||||||||||||||||
Time * White blood cell counts | 0.9993 [0.9990; 0.9996] | 0.9993 [0.9989; 0.9996] | 0.9992 [0.9990; 0.9996] |
Influence of SEP on therapeutic strategies
Model 2.0 (M2.0) | Model 2.1 | Model 2.2 | Model 2.3 | Model 2.4 | Model 2.5 | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
M2.0 + perf. Status | M2.0 + AML ontogeny | M2.0 + WBC | M2.0 + cytogen. Progn. | Fully adjusted | ||||||||||||
OR | [95% CI] | OR | [95% CI] | OR | [95% CI] | OR | [95% CI] | OR | [95% CI] | OR | [95% CI] | |||||
Age | 0.79 | [0.76; 0.82] | 0.79 | [0.76; 0.82] | 0.76 | [0.73; 0.80] | 0.77 | [0.74; 0.81] | 0.76 | [0.73; 0.80] | 0.74 | [0.70; 0.79] | ||||
Sex | Men | ref | ref | ref | ref | ref | ||||||||||
Women | 0.65 | [0.40; 1.05] | 0.65 | [0.40; 1.04] | 0.61 | [0.36; 1.03] | 0.73 | [0.44; 1.22] | 0.84 | [0.50; 1.44] | 0.71 | [0.40; 1.24] | ||||
Patients’ SEP (quintile of deprivation score) | Q1 – least | ref | ref | Ref | ref | ref | ||||||||||
Q2 | 0.46 | [0.22; 0.99] | 0.46 | [0.21;0.99] | 0.52 | [0.23; 1.17] | 0.43 | [0.20; 0.96] | 0.47 | [0.20; 1.09] | 0.47 | [0.20; 1.14] | ||||
Q3 | 0.98 | [0.49; 1.95] | 0.97 | [0.48; 1.95] | 1.07 | [0.51; 2.25] | 0.97 | [0.47; 2.01] | 0.77 | [0.36; 1.65] | 1.08 | [0.48; 2.41] | ||||
Q4 | 0.55 | [0.28; 1.08] | 0.56 | [0.28; 1.12] | 0.58 | [0.28; 1.20] | 0.54 | [0.27; 1.09] | 0.45 | [0.21; 0.96] | 0.58 | [0.26; 1.27] | ||||
Q5 – most | 0.41 | [0.19; 0.90] | 0.45 | [0.20; 0.98] | 0.59 | [0.25; 1.40] | 0.40 | [0.17; 0.93] | 0.45 | [0.19; 1.07] | 0.60 | [0.23; 1.53] | ||||
Charlson comorbidity index | 0 | ref | ref | ref | ref | ref | ||||||||||
1 | 0.61 | [0.33; 1.13] | 0.63 | [0.34; 1.17] | 0.66 | [0.34; 1.29] | 0.58 | [0.30; 1.10] | 0.70 | [0.36; 1.37] | 0.69 | [0.34; 1.40] | ||||
2+ | 0.64 | [0.35; 1.17] | 0.66 | [0.35; 1.22] | 1.05 | [0.54; 2.03] | 0.55 | [0.29; 1.05] | 0.59 | [0.30; 1.15] | 1.06 | [0.52; 2.18] | ||||
Undefinable | 0.14 | [0.06; 0.35] | 0.18 | [0.07; 0.46] | 0.19 | [0.07; 0.50] | 0.13 | [0.05; 0.32] | 0.31 | [0.12; 0.82] | 0.18 | [0.06; 0.55] | ||||
Performance status | 0/1 | ref | Ref | |||||||||||||
2 | 0.45 | [0.23; 0.86] | 0.38 | [0.18; 0.81] | ||||||||||||
3/4 | 0.77 | [0.34; 1.74] | 0.3 | [0.11; 0.82] | ||||||||||||
Undefinable | 0.6 | [0.27; 1.36] | 0.74 | [0.30; 1.83] | ||||||||||||
AML ontogeny | AML de novo | ref | ref | |||||||||||||
Secondary (post MDS or post treatment) | 0.13 | [0.07; 0.23] | 0.12 | [0.06; 0.22] | ||||||||||||
Undefinable | Not estimated | Not estimated | ||||||||||||||
White blood cell (WBS) counts (tercile) | Tercile 1 – low | Ref | ref | |||||||||||||
Tercile 2 – intermediate | 1.5 | [0.82; 2.75] | 1.86 | [0.95; 3.65] | ||||||||||||
Tercile 3 – high | 5.74 | [3.06; 10.79] | 7.83 | [3.82; 16.08] | ||||||||||||
Undefinable a | Not estimated | Not estimated | ||||||||||||||
Cytogenetic prognosis | Favorable/Intermediate | ref | ref | |||||||||||||
Unfavorable | 0.14 | [0.08; 0.25] | 0.12 | [0.06; 0.22] | ||||||||||||
Undefinable a | Not estimated | Not estimated |
Model 3.0 (M3.0) | Model 3.1 | Model 3.2 | Model 3.3 | ||||||
---|---|---|---|---|---|---|---|---|---|
M3.0 + perf. Status | M3.0 + WBC | Fully adjusted | |||||||
OR | [95% CI] | OR | [95% CI] | OR | [95% CI] | OR | [95% CI] | ||
Age | 0.94 | [0.91; 0.97] | 0.96 | [0.92; 0.99] | 0.95 | [0.92; 0.98] | 0.96 | [0.93; 0.99] | |
Sex | Men | ref | ref | ref | ref | ||||
Women | 1.39 | [0.88; 2.20] | 1.56 | [0.96; 2.52] | 1.41 | [0.88; 2.25] | 1.56 | [0.96; 2.55] | |
Patients’ SEP (quintile of deprivation score) | Q1 – least | ref | ref | ref | ref | ||||
Q2 | 1.02 | [0.50; 2.09] | 0.89 | [0.42; 1.89] | 0.94 | [0.45; 1.98] | 0.85 | [0.40; 1.84] | |
Q3 | 1.09 | [0.54; 2.20] | 1.05 | [0.50; 2.21] | 1.07 | [0.52; 2.19] | 1.06 | [0.50; 2.26] | |
Q4 | 1.12 | [0.56; 2.25] | 1.04 | [0.51; 2.13] | 1.04 | [0.51; 2.12] | 1.00 | [0.48; 2.08] | |
Q5 – most | 1.05 | [0.51; 2.17] | 1.05 | [0.50; 2.22] | 1.06 | [0.50; 2.24] | 1.07 | [0.50; 2.32] | |
Charlson comorbidity index | 0 | ref | ref | ref | ref | ||||
1 | 0.42 | [0.23; 0.75] | 0.47 | [0.26; 0.86] | 0.43 | [0.23; 0.77] | 0.47 | [0.25; 0.86] | |
2+ | 0.43 | [0.23; 0.80] | 0.51 | [0.27; 0.98] | 0.42 | [0.22; 0.79] | 0.49 | [0.25; 0.94] | |
Undefinable | 0.10 | [0.06; 0.20] | 0.15 | [0.07; 0.29] | 0.12 | [0.06; 0.22] | 0.15 | [0.08; 0.31] | |
Performance status | 0/1 | ref | ref | ||||||
2 | 0.88 | [0.46; 1.68] | 0.92 | [0.48; 1.79] | |||||
3/4 | 0.21 | [0.10; 0.45] | 0.24 | [0.11; 0.52] | |||||
Undefinable | 0.36 | [0.20; 0.65] | 0.41 | [0.22; 0.76] | |||||
White blood cell (WBS) counts (tercile) | Tercile 1 – low | ref | ref | ||||||
Tercile 2 – intermediate | 0.76 | [0.44; 1.30] | 0.85 | [0.49; 1.49] | |||||
Tercile 3 – high | 0.41 | [0.23; 0.72] | 0.51 | [0.28; 0.92] | |||||
Undefinable | 0.13 | [0.03; 0.71] | 0.16 | [0.03; 0.93] |