Definition of Unfit for Standard Acute Myeloid Leukemia Therapy.
Determining who is fit or unfit for standard treatments among older adults with acute myeloid leukemia (AML) remains a challenge. However, available evidence can provide guidance on strategies to assess and categorize fitness. Evidence is strongest to guide identification of "frail" older adults at the time of diagnosis based on performance status, physical function, and comorbidity. Many older adults, with adequate performance status and comorbidity burden, however, may be better characterized as "vulnerable". These patients have subclinical impairments that limit resilience when stressed with intensive therapies. More sensitive assessment strategies are needed to differentiate fit and vulnerable older adults regardless of chronologic age. Research is ongoing to identify tools and approaches, such as geriatric assessment, that can enhance characterization of fitness for AML therapies. This review will highlight available evidence for assessment of fitness among older adults with AML and discuss implications for practice and research.
Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC, 27157, USA. hklepin@wakehealth.edu.
Heidi D
HD
Klepin
D000203:Activities of Daily Living; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D060825:Cognitive Dysfunction / Q000150:complications; D015897:Comorbidity; D015577:Geriatric Assessment; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000150:complications / Q000473:pathology / Q000628:therapy*
D000970:Antineoplastic Agents
Acute myeloid leukemia; Elderly; Fitness; Geriatric assessment; Older
J Geriatr Oncol. 2016 Jan;7(1):24-31
26527394
J Clin Oncol. 2011 Sep 1;29(25):3457-65
21810685
Blood. 2010 Nov 25;116(22):4422-9
20668231
Am J Geriatr Pharmacother. 2009 Jun;7(3):151-8
19616183
Crit Rev Oncol Hematol. 2009 Feb;69(2):168-74
18778950
Cancer. 2005 Aug 15;104(4):788-93
15973668
Blood. 2011 Mar 24;117(12):3473-4
21436081
J Clin Oncol. 2011 Apr 1;29(10):1290-6
21357782
Haematologica. 2014 Feb;99(2):308-13
24097631
J Clin Oncol. 1989 Sep;7(9):1268-74
2475589
Blood. 2006 May 1;107(9):3481-5
16455952
Br J Haematol. 2013 Aug;162(4):509-16
23786647
Haematologica. 2012 Dec;97(12):1916-24
22773600
Haematologica. 2008 Dec;93(12):1806-13
18838471
J Clin Oncol. 2012 May 20;30(15):1829-34
22508806
Leuk Res. 2013 Sep;37(9):998-1003
23747082
J Clin Oncol. 2012 Nov 10;30(32):3924-31
22851554
Leukemia. 2015 Mar;29(3):548-55
25092141
Hematology. 2012 Mar;17(2):53-8
22664041
Ann Oncol. 2013 Oct;24 Suppl 7:vii36-40
24001761
Blood. 2015 Mar 26;125(13):2068-74
25628469
Cancer. 2007 Apr 1;109(7):1376-83
17326052
BMC Cancer. 2015 May 26;15:430
26008690
Blood. 2005 Oct 15;106(8):2912-9
15994282
J Geriatr Psychiatry Neurol. 1995 Oct;8(4):238-42
8561839
Leuk Res. 2012 Apr;36(4):479-82
22192632
Leuk Res. 2016 Aug;47:142-8
27337292
Hematol Oncol. 2009 Sep;27(3):148-53
19274612
J Geriatr Oncol. 2012 Jul 1;3(3):228-237
22712030
J Gerontol. 1994 Mar;49(2):M85-94
8126356
Cancer. 2006 Mar 1;106(5):1090-8
16435386
Leuk Res. 2014 Mar;38(3):275-83
24439052
Arch Intern Med. 2002 Feb 25;162(4):457-63
11863480
J Gerontol A Biol Sci Med Sci. 2000 Apr;55(4):M221-31
10811152
Cancer. 2009 Jun 1;115(11):2472-81
19322894
JAMA. 2011 Jan 5;305(1):50-8
21205966
Cancer. 2013 Aug 1;119(15):2720-7
23633441
J Geriatr Oncol. 2011 Jan;2(1):11-17
23843929
Leuk Lymphoma. 2016;57(4):789-96
26377031
Oncologist. 2010;15(5):507-22
20418534
J Am Geriatr Soc. 2011 Oct;59(10):1837-46
22091497
N Engl J Med. 1995 Mar 2;332(9):556-61
7838189
Cancer. 2005 Nov 1;104(9):1998-2005
16206252
Br J Haematol. 2007 Feb;136(4):624-7
17223919
Blood. 2013 May 23;121(21):4287-94
23550038
Leuk Res. 2014 Oct;38(10):1184-90
25127690
Ann Oncol. 2014 Mar;25(3):675-81
24458474
J Clin Oncol. 2002 Jan 15;20(2):494-502
11786579
Blood. 2012 Apr 26;119(17):3890-9
22383796
Lancet. 2012 Apr 21;379(9825):1508-16
22482940
Leuk Res. 2012 Oct;36(10):1255-61
22726923
Haematologica. 2013 Feb;98(2):208-16
22875615
J Am Geriatr Soc. 2003 Mar;51(3):314-22
12588574
Leukemia. 2013 Apr;27(5):997-9
23653072
J Cancer Res Clin Oncol. 2006 Oct;132(10):665-71
16821071
J Geriatr Oncol. 2013 Apr;4(2):174-82
24071542
Crit Rev Oncol Hematol. 2007 Oct;64(1):19-30
17765568
J Gerontol A Biol Sci Med Sci. 2015 Sep;70(9):1148-55
25834194
Cancer. 2012 Jul 1;118(13):3377-86
22072065
Drugs Aging. 2009;26(6):519-36
19591526
Med Oncol. 2012 Jun;29(2):1077-81
21331819