Duval AML score: how the five-item points total works

The Duval AML score adds points for five items in acute myeloid leukemia (AML) that is in relapse or did not respond to induction: disease status, cytogenetic risk, donor HLA match, circulating blasts and performance status. The total runs from 0 to 6 and is grouped as 0, 1, 2, or 3 and above.

Not a medical device. Not a diagnosis or dosing recommendation.

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Hematology calculators
Duval M et al. · 2010
The Duval AML formula
Worked examples
Frequently asked questions

What is the Duval AML score?

Duval and colleagues published the score in the Journal of Clinical Oncology in 2010, from a Center for International Blood and Marrow Transplant Research (CIBMTR) analysis. The paper has separate tables for AML and acute lymphoblastic leukemia. Magent's calculator uses the AML table (Table 5).

The calculator returns the points total, the maximum of 6 and a risk_group of 0, 1, 2 or ge_3. Totals of 3 and above share one group.

This page explains the arithmetic. It doesn't say what a score means for a particular person.

The Duval AML formula

Duval AML = disease status + cytogenetics + donor HLA match
          + circulating blasts + performance status

disease status       primary induction failure or first remission > 6 months 0
                     first remission < 6 months 1
cytogenetics         good or intermediate 0 · poor 1
donor HLA match      HLA-identical sibling, or well or partially matched unrelated 0
                     mismatched unrelated 1
                     related donor other than an HLA-identical sibling 2
circulating blasts   present 1
Karnofsky or Lansky  below 90 1

maximum 6 · groups 0 / 1 / 2 / 3 or more

Exact expression the calculator uses:

Duval AML Table 5 = disease_group (pif_or_cr1_gt_6mo 0, cr1_lt_6mo 1) + cytogenetics (good_or_intermediate 0, poor 1) + hla_match (sibling_or_matched_unrelated 0, mismatched_unrelated 1, related_other 2) + circulating_blasts 1 + kps_lt_90 1; Duval 2010 AML only (not ALL); max 6; risk_group 0 / 1 / 2 / ge_3

Inputs

Input	Values	Points
`disease_group`	`pif_or_cr1_gt_6mo` · `cr1_lt_6mo`	0 · 1
`cytogenetics`	`good_or_intermediate` · `poor`	0 · 1
`hla_match`	`sibling_or_matched_unrelated` · `mismatched_unrelated` · `related_other`	0 · 1 · 2
`circulating_blasts`	yes or no	1 if yes
`kps_lt_90`	Karnofsky or Lansky below 90, yes or no	1 if yes

How the calculation works

Disease status: a first remission that lasted less than 6 months scores 1. Primary induction failure, or a first remission longer than 6 months, scores 0.
Cytogenetics: poor risk on the ECOG/SWOG classification scores 1.
Donor HLA match: a mismatched unrelated donor scores 1; a related donor other than an HLA-identical sibling scores 2.
Circulating blasts and performance status below 90 each score 1.
Add the points. Totals of 0, 1 and 2 are their own groups; 3 and above are grouped as ge_3.

Units

There are no measured units. Each item is a category or a yes/no flag set by the person entering it. A missing item or a value outside the listed categories is rejected with an error.

Worked examples

These use Magent's own expected values for the calculator.

Example 1: every item at 0

Primary induction failure, good or intermediate cytogenetics, HLA-identical sibling donor, no circulating blasts, performance status 90 or above.

All five items score 0.
Total 0 → group 0.

Example 2: a mismatched unrelated donor

Otherwise as Example 1.

Mismatched unrelated donor → 1.
Total 1 → group 1.

Otherwise as Example 1.

Related other donor → 2.
Total 2 → group 2.

Example 4: short first remission, poor cytogenetics and circulating blasts

HLA-identical sibling donor, performance status 90 or above.

1 + 1 + 0 + 1 + 0.
Total 3 → group ge_3.

Example 5: every item scoring

First remission under 6 months, poor cytogenetics, related other donor, circulating blasts, performance status below 90.

1 + 1 + 2 + 1 + 1.
Total 6, the maximum → group ge_3.

History of the Duval AML score

The calculator cites Duval and colleagues, Journal of Clinical Oncology, 2010 (volume 28, issue 23, pages 3730–3738). The abstract describes a CIBMTR registry analysis of patients who received a stem-cell transplant for acute leukemia in relapse or after primary induction failure. A multivariate analysis of factors known before the transplant was used to build a scoring system for survival.

When it's used

The score describes AML in relapse or primary induction failure, using factors known before a planned stem-cell transplant.

Where it's used

The score needs the remission history, a cytogenetic risk category, the donor's HLA match, a blood film result for blasts and a Karnofsky or Lansky performance status.

Who uses it

The person using the calculator assigns each category. The calculator adds the points and sets the group.

Limits of the calculation

The calculator doesn't read a karyotype, HLA-type a donor, count blasts or rate performance status. Every category comes from the person entering it.
It's the AML table. The acute lymphoblastic leukemia table in the same paper isn't used.
It doesn't return survival figures, and it isn't a decision about transplant.
This page doesn't say what to do with a score.

Clinical decisions belong to a qualified clinician who knows the patient.

Karnofsky Performance Status returns a numeric performance rating. The Duval score uses it as a yes/no item: below 90 or not.

Glossary

Primary induction failure: leukemia that did not go into remission with initial chemotherapy.
First complete remission (CR1): the first time the leukemia is no longer detectable.
HLA match: how closely the donor's tissue type matches the patient's.
Lansky score: a performance status scale for children, read like Karnofsky.

Common mistakes

Scoring a related donor as matched. A related donor other than an HLA-identical sibling scores 2.
Scoring primary induction failure as 1. It shares the 0-point category with a first remission longer than 6 months.
Expecting separate groups above 3. Totals of 3 to 6 are one group.
Using the AML table for acute lymphoblastic leukemia. The paper scores it separately.

Source

Duval M, et al. Hematopoietic stem-cell transplantation for acute leukemia in relapse or primary induction failure. J Clin Oncol. 2010;28(23):3730-3738. DOI: 10.1200/JCO.2010.28.8852. PMID: 20625136

Frequently asked questions

How is the Duval AML score calculated?

Add points for disease status, cytogenetics, donor HLA match, circulating blasts and performance status. The total is 0 to 6.

What are the Duval risk groups?

0, 1, 2, and 3 or more.

Does the score cover acute lymphoblastic leukemia?

No. This calculator uses the paper's AML table.

In the AML table, a related donor other than an HLA-identical sibling carries 2 points.

Does the calculator need a numeric Karnofsky score?

No. It takes a yes/no flag for a score below 90.