Tuesday, March 28, 2023
| Characteristic | No. | % | Median (range) |
|---|---|---|---|
| Age at diagnosis, y | 64 (60-75) | ||
| 60-64 | 54 | 51.4 | |
| 65-70 | 37 | 35.3 | |
| 71-75 | 14 | 13.3 | |
| Sex | |||
| Male | 65 | 61.9 | |
| Female | 40 | 38.1 | |
| AML disease type | |||
| De novo | 73 | 69.5 | |
| Secondary | 32 | 30.5 | |
| ELN 2017 criteria | |||
| Favorable | 24 | 22.9 | |
| Intermediate | 49 | 46.7 | |
| Poor | 32 | 30.5 | |
| Genetic mutation | |||
| Biallelic CEBPA | 6 | 5.7 | |
| NPM1 without FLT3- ITD or with FLT3-ITD (low) | 13 | 12.4 | |
| NPM1 with FLT3-ITD (high) | 10 | 9.5 | |
| FLT3-ITD (high) without NPM1 | 9 | 8.6 | |
| RUNX1 | 10 | 9.5 | |
| ASXL1 | 9 | 8.6 | |
| TP53 | 2 | 1.9 | |
| Laboratory findings at baseline | |||
| WBC × 109/L | 3.8 (0.3-345.7) | ||
| Hemoglobin | 9.1 (5.2-13.0) | ||
| Platelet count × 109/L | 68.0 (9.0-827.0) | ||
| Creatinine, mg/dL | 0.9 (0.5-1.7) | ||
| Albumin, g/dL | 3.8 (2.8-5.0) | ||
| Fibrinogen, mg/dL | 344.0 (57.0-500.0) | ||
| Lactate dehydrogenase, U/L | 471.0 (184.0-13 200.0) | ||
| Basic assessment | |||
| Cardiac function, LVEF (%) | 64.0 (52.0-74.2) | ||
| Pulmonary function | |||
| FEV-1 (%) | 88.0 (57.0-115.0) | ||
| Adjusted DLCO (%) | 77.0 (42.0-119.0) | ||
| ECOG PS | |||
| 0-1 | 98 | 93.3 | |
| 2 | 7 | 6.7 | |
| HCT-CI | |||
| ≥3 | 24 | 22.9 | |
| ≥4 | 15 | 14.3 | |
| ≥5 | 9 | 8.6 | |
| Wheatley index* | |||
| Score | 7 (4-14) | ||
| Good risk (4-6) | 52 | 49.5 | |
| Standard risk (7-8) | 30 | 28.6 | |
| Poor risk (≥9) | 23 | 21.9 | |
| AML scores† | |||
| ED score, % | 18.9 (6.1-52.4) | ||
| 1st quartile | 26 | 24.8 | |
| 2nd quartile | 26 | 24.8 | |
| 3rd quartile | 24 | 22.9 | |
| 4th quartile | 29 | 27.6 | |
| CR score, % | 61.3 (14.5-90.6) | ||
| 1st quartile | 27 | 25.7 | |
| 2nd quartile | 26 | 24.8 | |
| 3rd quartile | 28 | 26.7 | |
| 4th quartile | 24 | 22.8 | |
| Ferrara criteria† | |||
| Age 75 years or older | 1 | ||
| ECOG PS ≥3 | 0 | ||
| Heart (LVEF ≤50%) | 0 | ||
| Lungs (DLCO ≤65% or FEV-1 ≤65%) | 21 | ||
| Kidney (on dialysis) | 3 | ||
| Liver (LFT >3× normal values) | 4 | ||
| Infection (resistant to anti-infective therapy) | 0 | ||
| Mental illness or uncontrolled cognitive status | 0 | ||
| Any other comorbidity that the physician judged to be incompatible with chemotherapy | 0 | ||
| Unfit‡ | 28 | 26.7 |
Table 1. Baseline characteristics of the study cohort (N = 105)
DLCO, diffusing capacity of lungs for carbon monoxide; FEV-1, forced expiratory volume at 1 second; ITD, internal tandem duplication; LFT, liver function test; LVEF, left ventricular ejection fraction; WBC, white blood cell count.
Wheatley risk score comprises cytogenetic risk group, WBC group, ECOG PS, age group, and AML type.16
AML scores calculate the probability of CR or ED (%) with appropriate formula, including initial body temperature, hemoglobin, platelet count, fibrinogen level, lactate dehydrogenase level, age, cytogenetic/molecular risk classification, and AML type.14
Ferrara operation criteria define unfitness for intensive chemotherapy in AML. The definition of unfitness for intensive chemotherapy should require the fulfillment of ≥1 of 9 criteria.44
| GA category | Score | No. | % | Median (range) |
|---|---|---|---|---|
| Physical function assessment | ||||
| K-MBI as ADL measurement | 105 (24-05) | |||
| Impaired K-MBI | ≤100 | 10 | 9.5 | |
| K-IADL | 10 (10-28) | |||
| Impaired K-IADL | ≥12 | 31 | 29.5 | |
| SPPB | 10 (3-12) | |||
| Impaired SPPB | ≤8 | 37 | 35.2 | |
| Standing balance consists of 3 subsequent balance tests | ≤3 points | |||
| Side-by-side stand <10 s | 0 points | 0 | ||
| Semitandem stand <10 s | 0 points | 3 | 2.9 | |
| Tandem stand <10 s | 18 | 17.2 | ||
| 3.0-9.9 s | 1 point | 9 | 50.0 | |
| >3.0 s or cannot perform | 0 points | 9 | 50.0 | |
| Gait speed assessment (4 meters), ≥4.82 s | ||||
| <4.82 s | 4 points | 48 | 45.7 | |
| 4.82-6.20 s | 3 points | 27 | 25.7 | |
| 6.21-8.70 s | 2 points | 14 | 13.3 | |
| >8.70 s | 1 point | 6 | 5.7 | |
| Cannot perform | 0 points | 10 | 9.5 | |
| Sit-and-stand speed, 5 times (≥11.19 s) | ||||
| <11.19 s | 4 points | 46 | 43.8 | |
| 11.19-13.69 s | 3 points | 21 | 20.0 | |
| 13.70-16.69 s | 2 points | 17 | 16.2 | |
| >16.7 s | 1 point | 9 | 8.6 | |
| <60 s or cannot perform | 0 points | 12 | 11.4 | |
| Handgrip strength | ||||
| Dominant hand strength, kg | 28 (12-46) | |||
| Male | 34 (12-46) | |||
| Female | 21 (13-28) | |||
| Impaired handgrip strength, dominant hand (≤4th quartile) | 24 | 22.9 | ||
| Male | 10 | |||
| Female | 14 | |||
| Nutritional status assessment | ||||
| MNA | 25.5 (10.5-33.0) | |||
| Impaired MNA | ≤23.5 | 35 | 33.3 | |
| Social support assessment | ||||
| OARS | 16 (8-24) | |||
| Impaired OARS | ≥18 | 34 | 32.4 | |
| Cognition function assessment | ||||
| MMSE-KC | 26 (15-30) | |||
| Impaired MMSE-KC | ≤23 | 35 | 33.3 | |
| No cognitive impairment | 24-30 | 70 | 66.7 | |
| Mild cognitive impairment | 18-23 | 31 | 29.5 | |
| Severe cognitive impairment | 0-17 | 4 | 3.8 | |
| KNU-DESC | 0 (0-3) | |||
| Impaired KNU-DESC | ≥2 | 2 | 1.9 | |
| Psychological function assessment | ||||
| SGDS-K | 2 (0-15) | |||
| Impaired SGDS-K, moderate depressive symptom | ≥6 | 19 | 18.1 | |
| No depression | 0-5 | 86 | 81.9 | |
| Moderate depressive symptom | 6-9 | 9 | 8.6 | |
| Major depression | ≥10 | 10 | 9.5 | |
| PHQ-9 | 5 (0-27) | |||
| Impaired PHQ-9, mild depression | ≥6 | 50 | 47.6 | |
| No depression | 0-5 | 55 | 52.4 | |
| Mild depression | 6-8 | 18 | 17.1 | |
| Moderate depression | 9-14 | 19 | 18.1 | |
| Severe depression | ≥15 | 13 | 12.4 | |
| NCCN distress thermometer | 3 (0-10) | |||
| Impaired NCCN distress thermometer | ≥3 | 64 | 61.0 | |
Table 2. Baseline GA measures for the study cohort (N = 105)
ADL, activity of daily living.
This activity is intended for hematologists, oncologists, internists, geriatricians, and other clinicians caring for older patients (age > 60 years) with acute myeloid leukemia (AML).
The goal of this activity is to describe the prognostic value of multiparameter geriatric assessment (GA) domains on treatment tolerance and outcomes after intensive chemotherapy with cytarabine and idarubicin in 105 newly diagnosed older adults (age > 60 years) with AML, according to a single-institution prospective cohort study.
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