Conventional chemotherapy for acute myeloid leukemia in older adults: Impact on nutritional, cognitive, and functional status

Abstract

Objectives The impact of conventional treatment for acute myeloid leukemia (AML) on the nutritional, cognitive, and functional status of elderly patients is seldom studied. This assessment was performed in the context of the LAMSA 2007 trial. Methods The trial enrolled 424 patients with de novo AML. Among them, 316 benefited from geriatric assessment (GA) including nutritional, cognitive, and functional status and were scored according to Eastern Cooperative Oncology Group (ECOG) and sorror for the prediction of treatment toxicity, morbidity, and mortality. Patients were investigated at diagnosis for three times during follow‐up. Results This study showed that AML and its treatment have no impact on cognitive (P = .554) nor functional status (P = .842 for Activity of Daily Living and P = .087 for Instrumental Activities of Daily Living). The nutritional status improved over time (P = .041). None of these three parameters at baseline, associated or not with ECOG and sorror scores, impacted survivals or toxicities. Conclusions The cognitive, functional, and nutritional status had no impact in this cohort of fit elderly AML patients without unfavorable cytogenetics. The GA tools used provided no additional information compared with ECOG and sorror scores, to predict toxicity, morbidity, or mortality due to intensive chemotherapy.

Cognitive Function in Adults With Acute Myeloid Leukemia Treated With Chemotherapy

“…The 10 articles, from 8 independent studies, were published between 2009 and 2021 across 6 countries (Table 1). Four were prospective longitudinal, 18,22,24,25 4 were prospective cohort, 19,21,26,27 and 2 were cross-sectional 20,23 . Four studies used repeated assessments over time, and intervals ranged from a month to a couple cycles of chemotherapy, with total study duration of up to more than 12 months.…”

“…In the 5 studies for which cognitive function was not the main outcome, cognitive function was measured exclusively at baseline 20,21,23,26,27 . Most studies focused on geriatric assessment 19–22,26 . Three studies had cognitive function as the main outcome 23–25 …”

“…Two studies included participants with a diagnosis of MDS, 24,26 and 1 study recruited participants with other types of malignant hematological disease 23 . Most studies included participants with intensive chemotherapy only 19–22,25 . Two studies also included participants who were treated with supportive care or immunomodulatory agents (for MDS), which did not include chemotherapy 26,27 .…”

“…Among the 8 studies using objective assessment tools, 2 used the Mini-Mental State Examination (MMSE), 3 used the Modified Mini-Mental State Examination (3MS), 1 used the Montreal Cognitive Assessment, and 2 used a battery of neuropsychological assessments. For the 6 studies using the MMSE, 3MS, and Montreal Cognitive Assessment to assess overall cognitive function, 2 longitudinal studies assessed the change of cognitive function using the MMSE and 3MS, respectively, from diagnosis of AML up to the end of consolidation chemotherapy and found that cognitive function remained stable over time ( P = .55 and P = .72, respectively) 19,22 . In addition to reporting mean or median score, a specific cutoff score for cognitive impairment was defined, and the prevalence of cognitive impairment was further identified.…”

Progress and Challenges in Survivorship After Acute Myeloid Leukemia in Adults

“…The estimated prevalence on cognitive dysfunction in hematologic cancer survivors was 17.2% in working memory, 35.2% in executive function, and impairment in working memory was associated with worsening survival [ 59 ]. AML chemotherapy did not have impact in cognitive or functional status [ 60 , 61 ].…”