The selection of chemotherapy for older patients (age over 60) with acute leukemia (AL) is challenging. High intensity chemotherapy offers a potential cure but has higher mortality in the first month. Low intensity chemotherapy offers a median survival of 15 months, but no chance of cure. Mortality during induction can be influenced by a variety of factors, including patient health (comorbidities, multiple medications, deconditioning), cancer cytogenetics (unfavorable), and treatment factors (high intensity vs low intensity chemotherapy). The aim of this project is to determine whether prognostic and survival assessment scales, which take some of these factors into account, correlate with mortality during high intensity induction of chemotherapy. This will be done through a retrospective chart review of patients treated for AL at WRH between 2017 and 2023. Chemotherapy regimen (high vs low intensity), mortality data, and prognostic scales will be collected. The prognostic scales used will be the Charlson Comorbidity Index (CCI) and the Hematopoietic Cell Transplant Comorbidity Index (HCT-CI). These scales are used to predict prognosis and overall survival, and similar outcomes in stem cell transplant, but this has not been studied extensively for mortality in AL patients. Identifying a correlation between the CCI and HCTCI in mortality with intensive induction chemotherapy could help clinicians guide treatment choices, optimize chemotherapy regimens, and reduce mortality during induction.

Our expected outcome is to demonstrate that the HCT-CI and CCI scales will predict the mortality rate during induction chemotherapy in AL patients. If our hypothesis is correct, this will be incorporated into patient assessment at Windsor Regional Hospital, and aid in the selection of chemotherapy for AL in Windsor. In addition, we will document the significant challenge in making decisions regarding chemotherapy when leukemia cytogenetics information is delayed until after the decision has to be made. This information will be used to influence the providers of this information in expediting cytogenetics in acute leukemia patients.