Created by: Hehn (ELIC) , generated 2011/10/24 , last changed: 2012/03/14

For patients aged 15 to 60 years with complete remission after induction therapy

The AML post-remission treatment (PRT) score was developed on the base of 586 AML patients aged 15 to 60 years. The patients had been treated within the prospective AML96 trial of the Study Alliance Leukemia (SAL) and all patients had achieved complete remission after double induction therapy. The PRT score was based on the association between potentially prognostic (baseline) variables and overall survival after complete remission. Assessment was performed by Cox regression analysis which was stratified for the three post-remission treatment strategies: chemotherapy with high-dose cytarabine, allogeneic, or autologous hematopoietic stem cell transplantation (HSCT).

As a prognostic tool, the score provides three statistically significantly different risk groups with regard to overall survival after complete remission. However, the PRT score is also of predictive value as it provided groups wherein on one hand the prognosticated survival probabilities due to baseline characteristics were similar, and on the other hand, they differed significantly between treatment strategies. Demonstrating both qualities, our PRT-score groups strongly support risk-adapted treatment: When comparing allogeneic HSCT, high-dose cytarabine, and autologous HSCT within each of the three PRT score groups, the patients in the favourable group had the longest survival after allogeneic HSCT, and the patients in the intermediate group showed the best survival after autologous HSCT.
The PRT score is calculated by the formula:

PRT score =

0.02017 x [Age in completed years]
+ 0.51305 x [1, if high-risk cytogenetics or secondary AML was present;0, otherwise]
+ 0.69896 x [1, if FLT3-ITD mutant-to-wild-type ratio > 0.8; 0, otherwise]
- 1.27241 x [(% CD34-positive blasts + 1)^-0.5]
When choosing your values in order to calculate the PRT score for your patient, please consider the following aspects:

• All variables should be evaluated at diagnosis of the patient.
• Age should be given in completed years. Patients should be between 15 and 60 years of age.
• Cytogenetic risk stratification was in accordance with the scientific knowledge at the time the study was set up (Walker H, Smith FJ, Betts DR. Blood Rev. 1994; 8: 30-6): High-risk cytogenetic abnormalities were defined by complex karyotype (defined as ≥ 3 independent abnormalities), -5/del(5q), -7/del(7q), hypodiploid karyotypes (other than -X, -Y) abnl3q, abnl11q, abnl12p, t(6;9), t(9;22), t(9;11), +11, +13, +21 or +22. Apart from the t(8;21) translocation – whether accompanied by further abnormalities or not – all other abnormalities were included in the intermediate-risk cytogenetic profile. Please choose cytogenetic risk by clicking on the appropriate group. Your choice will be indicated by a blue background colour.
• Secondary AML was defined by a prior myelodysplastic syndrome or therapy-related AML. Please choose disease status by clicking on the appropriate group. Your choice will be indicated by a blue background colour.
• The FLT3-ITD mutant-to-wild-type ratio should be rounded to two decimal places.
• The percentage of CD34-positive cells should be rounded to full percentage values.

Online calculator for the predictive AML post-remission treatment score
Age in completed years:
Cytogenetic risk group:	- intermediate risk high risk
Disease status:	- de novo AML secondary AML
FLT3-ITD mutant-to-wild-type ratio:
CD34-positive blasts:	%
Risk Score Group:
Risk Score:
The PRT score is rounded to three decimal places. A PRT score value <= 0.610 defines the favourable-score group. A PRT score value > 0.610 but <= 1.244 defines the intermediate-score group. A PRT score value > 1.244 defines the unfavourable-score group.
Acknowledgement: The help of Stefan Döring in programming the online calculator and of Arthur Gil in preparing the manuscript is gratefully appreciated.
Pfirrmann M, Ehninger G, Thiede C, Bornhäuser M, Kramer M, Röllig C, Hasford J, and Schaich M, for the Study Alliance Leukaemia (SAL). Prediction of post-remission survival in acute myeloid leukaemia: a post-hoc analysis of the AML96 trial. Lancet Oncol. 2012 Feb;13(2):207-214.