Integrating geriatric assessment and genetic profiling to personalize therapy selection in older adults with acute myeloid leukemia

Vijaya R. Bhatt, Christopher Wichman, Zaid S. Al-Kadhimi, Thuy T. Koll, Alfred L. Fisher, Ram I. Mahato, R. Katherine Hyde, Ann Berger, James O. Armitage, Sarah A. Holstein, Lori J. Maness, Krishna Gundabolu

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

Introduction: Survival benefit associated with intensive over low-intensity chemotherapy in older adults with acute myeloid leukemia (AML) is controversial. Geriatric assessment and genetic risk categories correlate with survival following intensive chemotherapy in older adults with AML and can guide treatment selection. Materials and methods: In a single-center trial, we integrated both geriatric assessment, and genetic risk categories to personalize selection of intensive versus low-intensity chemotherapy in older adults ≥60 years with AML (NCT03226418). In the present report, we demonstrate feasibility of this approach. Results: Broad eligibility criteria and co-management of patients with community oncologists allowed enrollment of 45% of all patients with AML treated at our center during the study period. The median time from enrollment to therapy initiation was two days (range 0–9). Over half of the trial patients had a score of ≥3 on hematopoietic cell transplantation comorbidity index, impairment in physical function (Short Physical Performance Battery), and Montreal Cognitive Assessment. Three fit patients received intensive chemotherapy, whereas other patients received low-intensity chemotherapy. Mortality at 30 days from diagnosis was 3.7% (95% confidence interval [CI] 0.7–18.3%) and at 90 days was 29.6% (95% CI 15.9–48.5%). One-year overall survival was 66% (95% CI 60–87%). Discussion: Our data demonstrate the feasibility of integrating geriatric assessment in precision oncology trials to define fitness for intensive chemotherapy. Broad eligibility criteria and academic-community collaboration can expand access to clinical trials.

Original languageEnglish (US)
Pages (from-to)871-874
Number of pages4
JournalJournal of Geriatric Oncology
Volume13
Issue number6
DOIs
StatePublished - Jul 2022
Externally publishedYes

Keywords

  • Acute myeloid leukemia
  • Chemotherapy
  • Clinical trial
  • Geriatric assessment
  • Precision-oncology

ASJC Scopus subject areas

  • Oncology
  • Geriatrics and Gerontology

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