Researchers found that the Charlson-Deyo Comorbidity Index (CCI) was an independent predictor of survival in older patients with acute promyelocytic leukemia (APL). The study results were recently published in the journal Leukemia & Lymphoma.

APL incidence rises significantly with age. “Although APL is highly curable in younger adults, older adults are at a significantly higher risk of early mortality and reduced overall survival (OS),” the study investigators wrote in their report. They aimed to determine the contribution that comorbidities may have in survival outcomes with age in patients with APL.

The researchers examined data from the National Cancer Database to explore relationships between CCI and survival outcomes in adult patients with APL who were aged 60 years and older. The primary endpoints were 1-month mortality and overall survival (OS). Patients were stratified into 3 CCI categories for analyses, with groups defined by CCI scores of 0, 1, or ≥2.

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There were 2221 patients included in the study, 45% of whom were older than 70 years. Across the study population, the CCI score was 0 in approximately 59% of patients, while it was 1 in 27%, and ≥2 in 14%. Patients with a CCI of 0 more often had private insurance and a higher income than did patients in the other CCI categories.

The 1-month mortality rates were 16% in the group with a CCI of 0, 24% with a CCI of 1, and 32% with a CCI of ≥2. In analyses adjusted for covariates, with the group having a CCI of 0 serving as a reference, risks of 1-month mortality were higher for the other groups. These equated to an odds ratio (OR) of 1.67 (95% CI, 1.29-2.16; P <.001) for the group with a CCI of 1, and an OR of 2.31 (95% CI, 1.70-3.13; P <.001) for those with a CCI of ≥2.

OS rates at 3 years were 61% for patients with a CCI of 0, 53% for those with a CCI of 1, and 38% for those with a CCI ≥2. In adjusted analyses, with patients having a CCI of 0 serving as a reference, worse OS was associated with a hazard ratio (HR) of 1.27 (95% CI, 1.10-1.46; P =.0008) for patients with a CCI of 1, and an HR of 1.74 (95% CI, 1.48-2.06; P <.0001) for patients with a CCI of ≥2.

“This large study of over two thousand older adults establishes that CCI is independently associated with outcomes in APL,” the study investigators wrote in their report. “The study results can inform estimates of mortality and OS based on comorbidity burden and facilitate patient counseling and education,” they continued.

Disclosures: Some authors have declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.


Dhakal P, Lyden E, Joshi U, et al. Comorbidity burden and outcomes of older adults with acute promyelocytic leukemia: a National Cancer Database analysis of 2221 patients. Leuk Lymphoma. Published online January 11, 2023. doi:10.1080/10428194.2023.2165394.

This article originally appeared on Oncology Nurse Advisor