title: Impairment in functional status and survival in patients with acute myeloid leukaemia.
abstract: Acute myeloid leukaemia (AML) is mainly affecting elderly patients. Elderly patients are increasingly affected by impairment of functional status (FS). FS is of prognostic relevance for survival in different tumours. Data for patients with AML are rare. Within a prospective trial we recruited patients with newly diagnosed AML and measured FS by two different methods: Karnofsky performance status (KPS) and instrumental activities of daily living (IADL). Sixty-three patients aged 19-85 years (median 61.1) were included. Twenty-three had prior myelodisplastic syndrome (MDS), 7 favourable, 17 unfavourable karyotype. Fifty received induction chemotherapy, 13 palliative chemotherapy. Median survival was 15.2 months (95% CI, 10.8-22.3) in all patients. Age, cytogenetic risk group, and impaired KPS and IADL significantly influenced median survival in univariate analysis. Impairment of IADL was the single most predictive variable. In multivariate analysis, impairment of IADL Score (HR:4.3, 95% CI 1.7-10.5, P = 0.001) and of KPS (HR:4.8, 95% CI 1.9-12.3, P = 0.001), and unfavourable cytogenetic risk group (HR:6.0, 95% CI 2.5-14.3, P < 0.001) significantly predicted median survival. In patients with AML, FS and not age is a major predictor of survival. The influence of FS is independent from cytogenetic risk group. IADL measurement adds information to KPS. The results have to be confirmed in a large sample of patients.
authors.affiliation: Clinic for Internal Medicine II, Department of Hematology and Medical Oncology, Friedrich Schiller University, Erlanger Allee 101, 07747, Jena, Germany. ulrich.wedding@med.uni-jena.de
authors.forename: Ulrich
authors.initials: U
authors.lastname: Wedding
authors.forename: Bernd
authors.initials: B
authors.lastname: Röhrig
authors.forename: Almuth
authors.initials: A
authors.lastname: Klippstein
authors.forename: Hans-Joerg
authors.initials: HJ
authors.lastname: Fricke
authors.forename: Herbert G
authors.initials: HG
authors.lastname: Sayer
authors.forename: Klaus
authors.initials: K
authors.lastname: Höffken
mesh_terms: D000203:Activities of Daily Living; D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007621:Karyotyping; D007951:Leukemia, Myeloid / Q000175:diagnosis* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D016019:Survival Analysis