Geriatric assessment in AML treatment selection may impact early mortality rates
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Key takeaways:
- Predicting treatment risk using geriatric assessment and genetic profiling for AML may impact early rates of mortality among patients aged 60 years or older.
- Geriatric assessment showed a high rate of impairment in objective physical and cognitive function.
SAN DIEGO — Personalizing treatment using both geriatric assessment and genetic profiling may decrease rates of early mortality among older patients with acute myeloid leukemia, according to a study from ASH Annual Meeting and Exposition.
“The trial had broad eligibility criteria and allowed patients with various comorbidities such as advanced liver or kidney problems or other concurrent malignancies to participate,” Vijaya Raj Bhatt, MBBS, MS, an associate professor, section leader of malignant hematology and medical director of the leukemia program at University of Nebraska Medical Center, told Healio. “The trial also allowed receiving chemotherapy through community oncology offices.”
Bhatt and colleagues used a geriatric assessment consisting of physical function, cognitive function and comorbidity burden to personalize the selection of therapy among patients aged 60 years or older with a new diagnosis of acute myeloid leukemia and determine patient health for undergoing intensive chemotherapy. The assessment also included the Karnofsky Performance Scale, the Patient Health Questionnaire-9 and the Mini Nutritional Assessment-Short Form, while genetic profiling was assessed using karyotyping and criteria from the 2017 European LeukemiaNet.
According to the abstract, patients with good or intermediate-risk AML received intensive chemotherapy, while patients with high-risk AML, organ dysfunction and/or requiring treatment for another malignancy received low-intensity chemotherapy. Patients were evaluated for quality of life and functional and oncologic outcomes.
Between July 2017 and October 2022, 75 patients consented to be in the study, but two failed screening. Of the remaining 73 eligible patients, the median age was 69 years, 49% were women, 92% were white and the median score on the Karnofsky Performance Scale was 80. The researchers reported that 55% of patients had three or more comorbidities, 70% had impaired physical function measured by Short Physical Performance Battery and 64% had impaired cognition measured by Montreal Cognitive Assessment. Of the AML genetic risk categories, 62% of patients were adverse, 22% were intermediate and 16% were good risk.
The results showed 10% (n = 7) of patients received intensive chemotherapy, while 90% (n = 66) received low-intensity chemotherapy. From diagnosis to treatment initiation, it took a median of 6 days, and from study enrollment to treatment initiation it took a median of 1 day.
According to the study, the rate of mortality was 6.8% (95% CI; 3–15.1) 30 days from diagnosis and 21.5% (95% CI; 14–32.7) at 90 days.
“Early mortality rates were very favorable, compared with other clinical trials done in older adults with AML despite broad eligibility criteria,” Bhatt said. “Our model to personalize AML therapy selection represents an innovative approach to precision medicine that incorporates both geriatric assessment for patient profiling and genetic profiling of leukemia cells. We were able to demonstrate that such a strategy is feasible and is not associated with delays in treatment initiation.”
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Bhatt VR, et al. Abstract 4265. Presented at: ASH Annual Meeting and Exhibition; Dec. 9-12, 2023; San Diego.
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