The Application Of Comprehensive Geriatric Assessment In Elderly Acute Myeloid Leukemia

Objectives To analyze the results of comprehensive geriatric assessment(CGA)in elderly(≥60years)patients with newly diagnosed acute myeloid leukemia in China.And to evaluate the feasibility and potential value of this assessment tool(CGA)in Chinese patients.Methods We prospectively collected and analyzed the CGA results(including the assessment of ECOG,ADL,IADL,MMSE,MNA-F,HCT-CI,and GDS)of 83 newly diagnosed AML(non APL)patients from 13 hospitals in Beijing and Tianjin between March 2016 and December 2017.The clinical data,treatment and follow-up information,as well as survival data were also collected;and the correlation between CGA and prognosis was analyzed.Results A total of 83 newly diagnosed elderly AML patients were enrolled in the study.The median age was 66 years(60-81 years).The most common type of AML was M2,which accounted for 55.4%(46 patients)of all cases included.According to the NCCN risk stratification criteria,11 cases(13.3%)were categorized into the favorable-risk group,38 cases(45.8%)into the intermediate-risk group,and 24 cases(21.1%)into the poor-risk group.81 patients(97.6%)completed all designated CGA assessment.16 patients(19.3%)were shown to have no impairments according to the geriatric assessment scales implemented by this study;while one patient(1.2%)was shown to have impairments of every scale assessed.The median number of impaired scales of the CGA assessment in the studied population was two.The distribution of impaired scales was as follows:impairment in ADL,55.4%;IADL impairment,42.2%;MNA-SF impairment,48.2%;cognitive impairment,15.7%;GDS impairment,31.7%;HCT-CI impairment,19.5%.The median ECOG score was 1 point for the enrolled elderly patients;the results of ECOG assessment in 46 patients(55.4%)were ’good,(defined as<two points).Utilizing ECOG as a grouping parameter:in patients with ’good’ ECOG,the proportion of impairment for each individual CGA scale ranged from 6.5%to 37%and 32 patients(68.9%)had at least one impaired CGA scale;on the other hand,in patients with ’bad’ECOG(defined as ≥two points),two patients(5.6%)had no other CGA impairments.CGA classification was significantly correlated with median OS(p=0.05).The healthy group was significantly better than that in the non-healthy group(all did not reach,p=0.05).Conclusions CGA is a tool with feasibility for the comprehensive evaluation in elderly AML inpatients in China.There is a wide range of CGA abnormalities in elderly AML patients.Compared with age and ECOG,CGA may be more comprehensive in assessing patients’ physical condition.Finally,CGA abnormality is associated with the prognosis of elderly AML patients.