Abstract
The incidence of acute myeloid leukemia (AML) increases with age, but the outcomes for older adults with AML are poor due to underlying tumor biology, poor tolerance to aggressive treatment, and the physiologic changes of aging. Because of the underlying heterogeneity in health status, treatment decisions are difficult in this population. A geriatric assessment (GA) refers to the use of various validated tools to assess domains that are important in older adults including physical function, cognition, comorbidities, polypharmacy, social support, and nutritional status. In older patients with cancer, a GA can guide treatment decision-making, predict treatment toxicity, and guide supportive care interventions. Compared to solids tumors, there is a relative lack of studies evaluating the use of a GA in older patients with AML. In this review, we will discuss the principles, common domains, feasibility, and benefits of GA, with a focus on older patients with AML that includes practical applications for clinical management.
Highlights
Acute myeloid leukemia (AML) is the most common type of acute leukemia in adults.The incidence of AML increases with age [1]
Program, over 57% of new cases of AML occur in adults aged 65 years or above (65–74 years: 23.7%; 75–84 years: 22.8%; and >84 years: 10.6%) [1]
Upfront treatment for adults with AML without significant comorbidities typically consists of intensive chemotherapy with an anthracycline-containing regimen
Summary
Over 57% of new cases of AML occur in adults aged 65 years or above (65–74 years: 23.7%; 75–84 years: 22.8%; and >84 years: 10.6%) [1]. Intensive chemotherapy in older adults is associated with treatment-related mortality of 10–20% and typically requires a prolonged period of hospitalization with significant treatment-associated disability [3,4,5]. For those who are not considered candidates for intensive chemotherapy, outpatient regimens such as hypomethylating agents (HMA) are considered [6,7,8]. Because of the heterogeneity of the underlying health of older adults with AML, determining which patients are candidates for aggressive treatments is not straightforward, making treatment decisions difficult in this population. We will discuss the principles, common domains, feasibility, and benefits of geriatric assessment, highlighting studies in the general cancer population and in older patients with AML
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