Geriatric Assessment Information Survival Prediction of AML Patients ‘Unfit’ for Intensive Treatment

Certain geriatric assessment (GA) measures were associated with survival among older adults with acute myeloid leukemia (AML) and represent candidate measures for screening those planned to receive lower intensity therapies, according to a new study.

Researchers conducted a companion study to the randomized, phase 2 CALGB 11002 study looking at the predictive utility of GA among adults aged 60 years or older with AML considered unfit for intensive therapy. In the companion study, 96 participants had GA and quality of life (QOL) assessed prior to treatment and every other subsequent cycle. Of these, 85.4% completed at least one baseline assessment.

Approximately one in five was unable to perform the Timed Up and Go test. Most participants screened negative for cognitive impairment and had no history of falls, had polypharmacy, moderate comorbidity, and reported adequate social support. Mean scores for global QOL were low.

Multivariate analyses showed that greater comorbidity, worse cognition, and lower European Organisation for Research and Treatment of Cancer global QOL scores at baseline were significantly associated with shorter overall survival (P<.05 for each) after adjustment for Karnofsky Performance Status, age, and treatment arm. For example, those with better cognitive function had a median overall survival of 10.4 months compared with 4.3 months for those with a worse cognitive screen score (P=.02).

The researchers noted that, “due to high attrition in this study, evaluation of change in GA measures and global QOL during treatment is limited.”

“The results of this study demonstrating the utility of GA to enhance characterization of older adults are consistent with a growing body of literature in both hematologic and non-hematologic malignancies,” the researchers wrote. “In the setting of AML, studies have shown that a GA performed at the time of initial treatment evaluation can provide information not routinely captured in oncology care in both the intensive and less intensive treatment settings.”

Based on these results and others, the use of GA can “guide [the] treatment decision to avoid ‘over and under-treatment’ for older adults with AML.”

Ritchie EK, Klepin HD, Storrick E, et al. Geriatric assessment for older adults receiving less intensive therapy for acute myeloid leukemia report of CALGB 361101. Blood Advances. 2022. doi:10.1182/bloodadvances.20211006872.