Validation of the "fitness criteria" for the treatment of older patients with acute myeloid leukemia: A multicenter study on a series of 699 patients by the Network Rete Ematologica Lombarda (REL). Issue 4 (May 2021)

• Record Type: Journal Article
• Authors: Borlenghi, Erika; Pagani, Chiara; Zappasodi, Patrizia; Bernardi, Massimo; Basilico, Claudia; Cairoli, Roberto; Fracchiolla, Nicola; Todisco, Elisabetta; Turrini, Mauro; Cattaneo, Chiara; Da Vià, Matteo; Ciceri, Fabio; Passamonti, Francesco; Mancini, Valentina; Sciumè, Mariarita; Cerqui, Elisa; Sciumè, Margherita; Rossi, Giuseppe
• Is Part Of: Journal of geriatric oncology. Volume 12:Issue 4(2021)
• Page Start: 550
• Page End: 556
• Publication Date: 2021-05
• Subjects: Acute myeloid leukemia -- Older -- Karyotype -- Treatment -- Fitness; AHD-AML acute myeloid leukemia secondary to an antecedent hematological disorder -- AML acute myeloid leukemia -- BSC best supportive care -- ECOG Eastern Cooperative Oncology Group -- ELN European Leukemia Net -- GA geriatric assessment -- GITMO Italian Group for Bone Marrow Transplantation -- HMA hypomethylating agents -- i-T intensive chemotherapy -- MRC Medical Research Council -- MNP myeloproliferative neoplasms -- MDS myelodysplastic Syndromes -- non i-T non intensive therapy -- OS overall survival -- Pts patients -- PS performance status -- REL Rete Ematologica Lombardas -- s-AML secondary acute myeloid leukemia -- SIE Italian Society of Hematology -- SIES Italian Society of Experimental Hematology -- t-AML therapy-related AML; Geriatric oncology -- Periodicals; Neoplasms -- Periodicals; Aged -- Periodicals; Geriatric oncology; Electronic journals; Periodicals; 618.976994005
• DOI: 10.1016/j.jgo.2020.10.004
• Languages: English
• ISSNs: 1879-4068

Abstract

Abstract: Objectives: Treatment of older patients with acute myeloid leukemia (AML) is still controversial. To facilitate treatment decisions, the "fitness criteria" proposed by Ferrara et al. (Leukemia, 2013), including age > 75 years, performance status and comorbidities, were verified retrospectively in 699 patients with AML (419 de-novo, 280 secondary AML), diagnosed at 8 Hematological Centers (REL). Methods: Patients were categorized in FIT to intensive chemotherapy (i-T) (292, 42.5%), UNFIT to i-T (289, 42.1%), or unfit even to non-intensive therapy (non i-T) (FRAIL) (105, 15.3%). Biological characteristics and treatment actually received by patients [i-T, 274 patients (39.2%); non i-T, 134 (19.2%), best-supportive care (BSC), 291 (41.6%)] were recorded. Results: "Fitness criteria" were easily applicable in 98.1% of patients. Overall concordance between "fitness criteria" and treatment actually received by patients was high (79.4%), 76% in FIT, 82.7% in UNFIT and 80% in FRAIL patients. Fitness independently predicted survival (median survival: 10.9, 4.2 and 1.8 months in FIT, UNFIT and FRAIL patients, respectively; p = 0.000), as confirmed also by multivariate analysis. In FRAIL patients, survival with any treatment was no better than with BSC, in UNFIT non i-T was as effective as i-T and better than BSC, and in FIT patients i-T was better than non i-T or BSC. In addition, a non-adverse risk AML, an ECOG PS <2, and receiving any treatment other than BSC had a favorable effect on survival ( p < 0.001). Conclusion: These simple "fitness criteria" applied at the time of diagnosis could facilitate, together with AML biologic risk evaluation, the choice of the most appropriate treatment intensity in older AML patients.