DEFINING FRAILTY OF ELDERLY PATIENTS WITH ACUTE MYELOID LEUKEMIA AT DIAGNOSIS
(Abstract release date: 05/19/16)
EHA Library. Audisio E. 06/09/16; 132487; E938
Ernesta Audisio
Contributions
Contributions
Abstract
Abstract: E938
Type: Eposter Presentation
Background
Background: Acute myeloid leukemia (AML) is a disease of older adults, with a median age at diagnosis over 65 years. Evaluation of disease-related and patients specific factors in the context of clinic decision making has therefore been largely subjective. Several studies demonstrated improved survival for older patients receiving intensive induction chemotherapy compared to those receiving supportive care alone. Defining this subset of patients who are not eligible or ”not fit” for intensive chemotherapy involves a great deal of subjectivity. Criteria yet have to be standardized across or within institutions.
Aims
Aim: Aim of this study was to investigate the validity of three validation scores for distinction of patient fitness at diagnosis in parallel to physician evaluation. Further patient outcome according the respective evaluation was compared.
Methods
Methods: A total of 69 clinically and molecularly well characterized consecutive elderly (>60 years) patients with newly diagnosed AML were treated from 2012 to 2015 according to age, performance status and co-morbidities in a single hematology center. Therapy response was defined according to ELN criteria. Therapy intensity decision was based on an initial haematologist evaluation followed by discussion in an interdisciplinary board. In parallel, the local geriatric G8 screening tool, the HCT-CI comorbidity score and the AML score proposed by the German Acute Myeloid Leukemia Cooperative Group, predicting probability of complete remission (CR) and early death (ED) were performed. Overall survival from diagnosis was compared between groups using the Cox model.
Results
Results: Thirty-three patients (47,8%) were evaluated “fit” by the medical board and treated by intensive chemotherapy, whereas 26 patients (37,7%) underwent semi-intensive/experimental therapy and 10 patients (14,4%) received best supportive care. A total of 21 patients (31,4%) achieved a complete remission after induction chemotherapy, whereas 49% patients (25%) were non responders and 13 (19,4%) died. Overall, the median survival time was 5,2 months (95% CI 3,5-8,3). Primary physician care evaluation was able to define in a statistically significant manner a “fit” from an “unfit” patient. Median survival time from the “fit” patients was 8,3 moths (95%CI 6,1-11,2) compared to the “unfit” evaluated patients with 2,9 months (95%CI 1,3-4,4), p=0,004. Parallel evaluation of patients fitness using the G8, HCT-CI and AML scores discriminated significantly “fit” from “unfit” patients considering median survival time, p=0,001, p=0,032 and 0,021, respectively.The ability of the frailty scores on the prediction of fitness classification compared to the physician evaluation was analyzed by calculating the area under the curve (AUC) using a logistic regression model. In this approach an AUC of 1,0 denotes perfect prediction whereas and AUC of 0,5 is analogous to a coin flip. With this regard the AUC for the G8 Score was 0,73, whereas the HCT-CI was 0,72 and the AML score ED 0,78 and the AML CR 0,79 in the present cohort.
Conclusion
Summary/Conclusion: In conclusion, in the present cohort the applied frailty scores at diagnosis correlated significantly regarding median overall survival. These results may encourage a following larger multi-centre analysis in order to verify the statistic power of the performed analysis.
Session topic: E-poster
Keyword(s): Acute myeloid leukemia, Elderly
Type: Eposter Presentation
Background
Background: Acute myeloid leukemia (AML) is a disease of older adults, with a median age at diagnosis over 65 years. Evaluation of disease-related and patients specific factors in the context of clinic decision making has therefore been largely subjective. Several studies demonstrated improved survival for older patients receiving intensive induction chemotherapy compared to those receiving supportive care alone. Defining this subset of patients who are not eligible or ”not fit” for intensive chemotherapy involves a great deal of subjectivity. Criteria yet have to be standardized across or within institutions.
Aims
Aim: Aim of this study was to investigate the validity of three validation scores for distinction of patient fitness at diagnosis in parallel to physician evaluation. Further patient outcome according the respective evaluation was compared.
Methods
Methods: A total of 69 clinically and molecularly well characterized consecutive elderly (>60 years) patients with newly diagnosed AML were treated from 2012 to 2015 according to age, performance status and co-morbidities in a single hematology center. Therapy response was defined according to ELN criteria. Therapy intensity decision was based on an initial haematologist evaluation followed by discussion in an interdisciplinary board. In parallel, the local geriatric G8 screening tool, the HCT-CI comorbidity score and the AML score proposed by the German Acute Myeloid Leukemia Cooperative Group, predicting probability of complete remission (CR) and early death (ED) were performed. Overall survival from diagnosis was compared between groups using the Cox model.
Results
Results: Thirty-three patients (47,8%) were evaluated “fit” by the medical board and treated by intensive chemotherapy, whereas 26 patients (37,7%) underwent semi-intensive/experimental therapy and 10 patients (14,4%) received best supportive care. A total of 21 patients (31,4%) achieved a complete remission after induction chemotherapy, whereas 49% patients (25%) were non responders and 13 (19,4%) died. Overall, the median survival time was 5,2 months (95% CI 3,5-8,3). Primary physician care evaluation was able to define in a statistically significant manner a “fit” from an “unfit” patient. Median survival time from the “fit” patients was 8,3 moths (95%CI 6,1-11,2) compared to the “unfit” evaluated patients with 2,9 months (95%CI 1,3-4,4), p=0,004. Parallel evaluation of patients fitness using the G8, HCT-CI and AML scores discriminated significantly “fit” from “unfit” patients considering median survival time, p=0,001, p=0,032 and 0,021, respectively.The ability of the frailty scores on the prediction of fitness classification compared to the physician evaluation was analyzed by calculating the area under the curve (AUC) using a logistic regression model. In this approach an AUC of 1,0 denotes perfect prediction whereas and AUC of 0,5 is analogous to a coin flip. With this regard the AUC for the G8 Score was 0,73, whereas the HCT-CI was 0,72 and the AML score ED 0,78 and the AML CR 0,79 in the present cohort.
Conclusion
Summary/Conclusion: In conclusion, in the present cohort the applied frailty scores at diagnosis correlated significantly regarding median overall survival. These results may encourage a following larger multi-centre analysis in order to verify the statistic power of the performed analysis.
Session topic: E-poster
Keyword(s): Acute myeloid leukemia, Elderly
Abstract: E938
Type: Eposter Presentation
Background
Background: Acute myeloid leukemia (AML) is a disease of older adults, with a median age at diagnosis over 65 years. Evaluation of disease-related and patients specific factors in the context of clinic decision making has therefore been largely subjective. Several studies demonstrated improved survival for older patients receiving intensive induction chemotherapy compared to those receiving supportive care alone. Defining this subset of patients who are not eligible or ”not fit” for intensive chemotherapy involves a great deal of subjectivity. Criteria yet have to be standardized across or within institutions.
Aims
Aim: Aim of this study was to investigate the validity of three validation scores for distinction of patient fitness at diagnosis in parallel to physician evaluation. Further patient outcome according the respective evaluation was compared.
Methods
Methods: A total of 69 clinically and molecularly well characterized consecutive elderly (>60 years) patients with newly diagnosed AML were treated from 2012 to 2015 according to age, performance status and co-morbidities in a single hematology center. Therapy response was defined according to ELN criteria. Therapy intensity decision was based on an initial haematologist evaluation followed by discussion in an interdisciplinary board. In parallel, the local geriatric G8 screening tool, the HCT-CI comorbidity score and the AML score proposed by the German Acute Myeloid Leukemia Cooperative Group, predicting probability of complete remission (CR) and early death (ED) were performed. Overall survival from diagnosis was compared between groups using the Cox model.
Results
Results: Thirty-three patients (47,8%) were evaluated “fit” by the medical board and treated by intensive chemotherapy, whereas 26 patients (37,7%) underwent semi-intensive/experimental therapy and 10 patients (14,4%) received best supportive care. A total of 21 patients (31,4%) achieved a complete remission after induction chemotherapy, whereas 49% patients (25%) were non responders and 13 (19,4%) died. Overall, the median survival time was 5,2 months (95% CI 3,5-8,3). Primary physician care evaluation was able to define in a statistically significant manner a “fit” from an “unfit” patient. Median survival time from the “fit” patients was 8,3 moths (95%CI 6,1-11,2) compared to the “unfit” evaluated patients with 2,9 months (95%CI 1,3-4,4), p=0,004. Parallel evaluation of patients fitness using the G8, HCT-CI and AML scores discriminated significantly “fit” from “unfit” patients considering median survival time, p=0,001, p=0,032 and 0,021, respectively.The ability of the frailty scores on the prediction of fitness classification compared to the physician evaluation was analyzed by calculating the area under the curve (AUC) using a logistic regression model. In this approach an AUC of 1,0 denotes perfect prediction whereas and AUC of 0,5 is analogous to a coin flip. With this regard the AUC for the G8 Score was 0,73, whereas the HCT-CI was 0,72 and the AML score ED 0,78 and the AML CR 0,79 in the present cohort.
Conclusion
Summary/Conclusion: In conclusion, in the present cohort the applied frailty scores at diagnosis correlated significantly regarding median overall survival. These results may encourage a following larger multi-centre analysis in order to verify the statistic power of the performed analysis.
Session topic: E-poster
Keyword(s): Acute myeloid leukemia, Elderly
Type: Eposter Presentation
Background
Background: Acute myeloid leukemia (AML) is a disease of older adults, with a median age at diagnosis over 65 years. Evaluation of disease-related and patients specific factors in the context of clinic decision making has therefore been largely subjective. Several studies demonstrated improved survival for older patients receiving intensive induction chemotherapy compared to those receiving supportive care alone. Defining this subset of patients who are not eligible or ”not fit” for intensive chemotherapy involves a great deal of subjectivity. Criteria yet have to be standardized across or within institutions.
Aims
Aim: Aim of this study was to investigate the validity of three validation scores for distinction of patient fitness at diagnosis in parallel to physician evaluation. Further patient outcome according the respective evaluation was compared.
Methods
Methods: A total of 69 clinically and molecularly well characterized consecutive elderly (>60 years) patients with newly diagnosed AML were treated from 2012 to 2015 according to age, performance status and co-morbidities in a single hematology center. Therapy response was defined according to ELN criteria. Therapy intensity decision was based on an initial haematologist evaluation followed by discussion in an interdisciplinary board. In parallel, the local geriatric G8 screening tool, the HCT-CI comorbidity score and the AML score proposed by the German Acute Myeloid Leukemia Cooperative Group, predicting probability of complete remission (CR) and early death (ED) were performed. Overall survival from diagnosis was compared between groups using the Cox model.
Results
Results: Thirty-three patients (47,8%) were evaluated “fit” by the medical board and treated by intensive chemotherapy, whereas 26 patients (37,7%) underwent semi-intensive/experimental therapy and 10 patients (14,4%) received best supportive care. A total of 21 patients (31,4%) achieved a complete remission after induction chemotherapy, whereas 49% patients (25%) were non responders and 13 (19,4%) died. Overall, the median survival time was 5,2 months (95% CI 3,5-8,3). Primary physician care evaluation was able to define in a statistically significant manner a “fit” from an “unfit” patient. Median survival time from the “fit” patients was 8,3 moths (95%CI 6,1-11,2) compared to the “unfit” evaluated patients with 2,9 months (95%CI 1,3-4,4), p=0,004. Parallel evaluation of patients fitness using the G8, HCT-CI and AML scores discriminated significantly “fit” from “unfit” patients considering median survival time, p=0,001, p=0,032 and 0,021, respectively.The ability of the frailty scores on the prediction of fitness classification compared to the physician evaluation was analyzed by calculating the area under the curve (AUC) using a logistic regression model. In this approach an AUC of 1,0 denotes perfect prediction whereas and AUC of 0,5 is analogous to a coin flip. With this regard the AUC for the G8 Score was 0,73, whereas the HCT-CI was 0,72 and the AML score ED 0,78 and the AML CR 0,79 in the present cohort.
Conclusion
Summary/Conclusion: In conclusion, in the present cohort the applied frailty scores at diagnosis correlated significantly regarding median overall survival. These results may encourage a following larger multi-centre analysis in order to verify the statistic power of the performed analysis.
Session topic: E-poster
Keyword(s): Acute myeloid leukemia, Elderly
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