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Impact of age, functional status, and comorbidities on quality of life and outcomes in elderly patients with AML: review

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Abstract

The incidence of acute myeloid leukemia increases with age, and more than half of AML patients are over 60 years old. Treating elderly AML patients presents several challenges and uncertainties, linked partly to disease characteristics and partly to the difficulty of establishing which patients could benefit from the best treatment. Although some elderly fit patients can receive intensive therapy, many of them are not treated and not enrolled in clinical trials. Yet supportive care is associated with significantly lower survival rates compared to intensive therapy or lower intensive therapy. A poorer prognosis in elderly patients is related to age, functional status, and comorbidities, combined with leukemia characteristics. Chronological age is not the best surrogate factor for selecting patients eligible for intensive chemotherapy. Scoring systems—including patient characteristics (ECOG, comorbidities) and disease characteristics (cytogenetics and molecular parameters)—designed to evaluate probabilities of response to treatment, morbidity, and survival may be used to balance the risk-benefit ratio for intensive therapy. A geriatric assessment (GA) to evaluate physical function, comorbidities, nutritional status, cognitive function, and social support could help identify the most vulnerable patients so that they can receive intensive therapy. A GA would also help take the necessary steps to improve tolerance to treatment. Evaluating markers of fitness and quality of life as part of clinical trials should be favored.

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Authors and Affiliations

  1. Department of Hematology, Centre Hospitalier Le Mans, 194 Avenue Rubillard, 72000, Le Mans, France

    Kamel Laribi

  2. Department of Hematology, The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada

    Mohamad Sobh

  3. Department of Hematology, Institut Gustave Roussy, 114 rue Edouard Vaillant, 94805, Villejuif, France

    David Ghez

  4. Geriatric Department, Assistance Publique-Hôpitaux de Paris, Hôpital Broca, 54-56 Pascal, 75013, Paris, France

    Alix Baugier de Materre

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  1. Kamel Laribi
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ABM and KL conceived, designed, directed, and supervised the study and revised the manuscript. MS and DG collected the data. KL analyzed the data and wrote the first manuscript draft. All the authors read, revised, and approved the final manuscript.

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Correspondence to Kamel Laribi.

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Outside this work, KL has received research grants from AbbVie, Novartis, Takeda, Roche, Amgen, and Sandoz as well as personal fees from AbbVie, Novartis, Sandoz, Celgene, Jansen, and Amgen. DG has received a research grant from Janssen and personal fees from Janssen, Abbvie, and Roche. ABM and MS declare that they have no conflicts of interest.

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Laribi, K., Sobh, M., Ghez, D. et al. Impact of age, functional status, and comorbidities on quality of life and outcomes in elderly patients with AML: review. Ann Hematol 100, 1359–1376 (2021). https://doi.org/10.1007/s00277-020-04375-x

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