A research team at St. Mary's Seoul Hospital has confirmed that an existing model that can predict nonfatal toxicities and survival in cancer patients has the same efficacy on elderly acute myeloid leukemia (AML) patients.
AML is a geriatric hematologic cancer with an average age of onset between 65 and 67 years of age. With the rapid progress of the aging population, the incidence rate has increased in recent years. AML patients aged 60 years or older have a poor prognosis due to the genetic characteristics of leukemia different from those of younger patients, as well as deterioration of organ function and decreased systemic performance due to aging.
Therefore, the vital first step for treatment in patients over 60 years of age is to conduct a fitness evaluation to decide whether standard chemotherapy is suitable as a first-line treatment.
In general, when evaluating the suitability of standard chemotherapy in an elderly patient, hospitals check age, systemic performance, and presence or absence of comorbidities. However, patients judged to be suitable often suffer from complications and late recovery in treatment.
Therefore, research has been ongoing to develop an ideal evaluation method that allows elderly patients to accurately evaluate individual differences and recovery ability and select customized treatment based on the results.
The elderly comprehensive evaluation is a comprehensive evaluation of various items that can affect the patient's adherence to chemotherapy and resilience, such as physical function, cognitive function, emotional state, nutritional status, social support base, and drug use.
Many hospitals recommend the evaluation before treatment in various cancers as it helps to predict the accurate prognosis based on patient-specific differences.
However, in AML, the usefulness of the comprehensive geriatric evaluation has not been proven.
To prove the efficacy of the elderly comprehensive evaluation, the research team conducted a pre-treatment geriatric comprehensive evaluation on 105 elderly patients with AML aged 60 years and older who received standard chemotherapy from 2016 to 2019 to analyze which items among evaluation are useful for predicting treatment-related complications, mortality, and survival rates.
Professors Cho Byung-shik and Min Ki-joon of the Department of Hematology led the research.
The study result confirmed that 92 percent of patients judged suitable for standard chemotherapy had abnormal findings in one or more items.
When the team confirmed physical dysfunction through a short physical performance battery (SPPB) test consisting of balancing, walking, sitting, and standing, or a cognitive dysfunction through a mini-mental state examination in the Korean version of the CERAD Assessment Packet, the risk of complications during chemotherapy increased by 2.7 to 3.9 times.
Also, the team confirmed that abnormalities in the SPPB test or the Korean version of the short form of the Geriatric Depression Scale (SGDS-K) are useful indicators to predict the treatment-related mortality and survival rate.
Notably, the researchers stressed that they could significantly improve symptoms by including items useful for predicting the survival rate in the elderly inclusive evaluation in various survival prediction models used in the past.
"Through this study, the team believes that the comprehensive evaluation of older adults will change the paradigm of treatment as an indicator of the initial treatment method selection for elderly patients with AML in the medical field," Professor Cho said. "We will conduct a study to verify whether the physical, mental and cognitive impairments discovered at the time of leukemia diagnosis can improve through appropriate treatment to improve chemotherapy outcomes."
The team is also analyzing the role of the elderly inclusive evaluation in low-intensity chemotherapy, Cho added.
The study was published in the online edition of Blood, the official journal of the American Society of Hematology, on Jan. 12 before its formal publication.