Geriatric Assessment in Older Patients with Acute Myeloid Leukemia

Abstract

The incidence of acute myeloid leukemia (AML) increases with age, but the outcomes for older adults with AML are poor due to underlying tumor biology, poor tolerance to aggressive treatment, and the physiologic changes of aging. Because of the underlying heterogeneity in health status, treatment decisions are difficult in this population. A geriatric assessment (GA) refers to the use of various validated tools to assess domains that are important in older adults including physical function, cognition, comorbidities, polypharmacy, social support, and nutritional status. In older patients with cancer, a GA can guide treatment decision-making, predict treatment toxicity, and guide supportive care interventions. Compared to solids tumors, there is a relative lack of studies evaluating the use of a GA in older patients with AML. In this review, we will discuss the principles, common domains, feasibility, and benefits of GA, with a focus on older patients with AML that includes practical applications for clinical management.

Low-intensity regimens versus standard-intensity induction strategies in acute myeloid leukemia

“…In the previous era of chemotherapy when toxicity and efficacy were closely linked, this composite definition of fitness made sense, but treatment options are changing and patient fitness should be distinguished from treatment appropriateness. 48 In conclusion, ICT benefits a subset of elderly patients with AML characterized by a younger age (i.e. less than 75), good performance status, few comorbidities, and with an AML belonging to either the favorable or intermediate-risk ELN 2017 categories.…”

“…Using this tool, researchers discovered that more than 30% of patients with AML older than 70 years had significant cognitive impairment. 48 The Short Physical Performance Battery was used to identify a subgroup of patients with increased risk of early mortality among patients with an ECOG performance status of 0-1. 49 However, geriatric assessment tools are not widely used and guidelines for the determination of fitness still recommend assessments based on classical parameters such as age, performance status, and comorbidities.…”

“…In the previous era of chemotherapy when toxicity and efficacy were closely linked, this composite definition of fitness made sense, but treatment options are changing and patient fitness should be distinguished from treatment appropriateness. 48…”

Outcomes of decitabine treatment for newly diagnosed acute myeloid leukemia in older adults​

“…The importance of geriatric assessment including nutritional status has been emphasized for a long time, and the use of an MNA-SF has been suggested as a useful tool for assessing older patients’ nutritional status [ 20 – 22 ]. Although various validated tools for geriatric assessment of AML patients were introduced [ 23 ], they have not been uniformly applied in clinical practice due to the diversity and complexity of the tools. Meanwhile, the MNA-SF consists of only 6 components pertaining to information about nutritional status, active daily living, psychological stress, and active disease.…”

Use of geriatric assessment in hematopoietic cell transplant

“…The feasibility and prognostic utility of GA in older adults with cancer were initially established in solid tumors [55][56][57][58]. Since these initial informative studies, evidence of the prognostic utility of GA in older adults with cancer, including hematologic malignancies, has expanded [59,60]. Likewise, emerging data suggests that GA among older HCT recipients can inform providers on areas of vulnerability prior to HCT as well as after ( Fig.…”