The respective usefulness of the G8 and a comprehensive geriatric assessment (CGA) to predict intolerance to chemotherapy and survival of fit and vulnerable older patients with hematological malignancies

Abstract

Introduction: Anemia in the elderly is associated with increased health impairments and might be an early sign of cancer. Objectives: To investigate the prevalence of anemia and its relationship with demographic data in the elderly in a well-defined cohort from a university hospital and to identify possible causes as assessed by laboratory parameters. Methods: Cross-sectional, retrospective analysis of inand outpatients from Innsbruck Medical University. All patients aged ≥64 years treated between 1.10.2004 and 29.9.2005 were included and evaluated. Results: In 19758 patients with a median age of 73 yrs, anemia as defined by the WHO was detected in 21.1%. Prevalance of anemia reached values of 30.7% and 37.0% at 80+ and 90+ yrs, respectively. The prevalence of anemia was significantly correlated with advanced age (r = 0.21; p b 0.001) and male sex (p b 0.001). Renal insufficiency with a GFR b60 or b 30 ml/min/1.73 m was observed in 45.1 or 11.3%, respectively, elevated C-reactive protein in 62.1%, absolute or relative functional iron deficiency in 14.4 and 28.2%, and folic acid or B12-deficiency in 6.7 or 2% of anemic patients, respectively. Low Hb-values were significantly correlated with elevated CRP-levels (r = -0.296; p b 0.001) and low transferrin saturation (r = 0.313; p b 0.001). Cytopenias suggestive of an underlying myelodysplastic syndrome (MDS) were found in a substantial proportion of anemic patients: thrombopenia b100G/l was found in 5.4%, leucopenia b4G/l in 8.3% and macrocytic alterations without evidence of vitamin B12or folic acid-deficiency in 16.4% of cases. Conclusion: Anemia in the elderly is frequent. As possible causes, a complex, partly treatable interplay of nutritional deficiencies, chronic inflammation and renal insufficiency was identified. In a relevant proportion a hitherto undiagnosed Myelodysplastic Syndrome can be assumed. The development of screening methods for MDS seems to be of major clinical relevance.