title: Geriatric assessment predicts survival for older adults receiving induction chemotherapy for acute myelogenous leukemia.
abstract: We investigated the predictive value of geriatric assessment (GA) on overall survival (OS) for older adults with acute myelogenous leukemia (AML). Consecutive patients ≥ 60 years with newly diagnosed AML and planned intensive chemotherapy were enrolled at a single institution. Pretreatment GA included evaluation of cognition, depression, distress, physical function (PF) (self-reported and objectively measured), and comorbidity. Objective PF was assessed using the Short Physical Performance Battery (SPPB, timed 4-m walk, chair stands, standing balance) and grip strength. Cox proportional hazards models were fit for each GA measure as a predictor of OS. Among 74 patients, the mean age was 70 years, and 78.4% had an Eastern Cooperative Oncology Group (ECOG) score ≤ 1. OS was significantly shorter for participants who screened positive for impairment in cognition and objectively measured PF. Adjusting for age, gender, ECOG score, cytogenetic risk group, myelodysplastic syndrome, and hemoglobin, impaired cognition (Modified Mini-Mental State Exam < 77) and impaired objective PF (SPPB < 9) were associated with worse OS. GA methods, with a focus on cognitive and PF, improve risk stratification and may inform interventions to improve outcomes for older AML patients.
authors.affiliation: Comprehensive Cancer Center of Wake Forest University, Winston-Salem, NC 27157, USA. hklepin@wakehealth.edu
authors.forename: Heidi D
authors.initials: HD
authors.lastname: Klepin
authors.forename: Ann M
authors.initials: AM
authors.lastname: Geiger
authors.forename: Janet A
authors.initials: JA
authors.lastname: Tooze
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Kritchevsky
authors.forename: Jeff D
authors.initials: JD
authors.lastname: Williamson
authors.forename: Timothy S
authors.initials: TS
authors.lastname: Pardee
authors.forename: Leslie R
authors.initials: LR
authors.lastname: Ellis
authors.forename: Bayard L
authors.initials: BL
authors.lastname: Powell
mesh_terms: D000342:Affective Symptoms / Q000175:diagnosis; D000368:Aged; D003071:Cognition; D015897:Comorbidity; D003863:Depression / Q000175:diagnosis; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D006801:Humans; D060828:Induction Chemotherapy / Q000379:methods*; D053208:Kaplan-Meier Estimate; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D055502:Secondary Prevention; D016896:Treatment Outcome
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