Study On The Application Of Geriatric Assessment,Inflammatory Biomarkers In Elderly Patients With Acute Myeloid Leukemia And The Correlation Between Them And Treatment Outcomes

BackgroundAbout 65% patients with acute myeloid leukemia are older than 60 years old at the time of diagnosis.Patients in this age group have poor response to treatment.After chemotherapy,the time of myeloproliferation is long and the risk of induction therapy is high.At present,the clinical evaluation of this type of patients and the prediction of treatment results are not perfect.ObjectiveTo investigate the changes in geriatric assessment(GA)and inflammatory biomarkers during induction therapy and to clarify their relevance to treatment outcomes.Methods20 newly diagnosed elderly patients with AML(age >60)who received induction therapy were recruited in the observation.This was a single-center prospective observational study.GA,Short Physical Performance Battery(SPPB),instrumental activities of daily living(IADL),iCenter for Epidemiological Studies-Depression(CES-D),was administered at baseline and post-induction.Fasting peripheral venous blood was collected from patients and inflammatory biomarkers,interleukin-6(IL-6),interleukin-6 soluble receptors(IL-6 sR),tumor necrosis factor alpha(TNF?),tumor necrosis factor alpha soluble receptor 1(TNF? sR1),C-reactive protein(CRP)were detected by enzyme-linked immunosorbent assay(ELISA)at start of induction,weekly for three weeks and post-induction.These data were compared using paired t-test.GA was correlated with inflammatory biomarkers level using Spearman correlations.Survival analysis was performed using Kaplan-Meier,and the relationship between survival and inflammatory biomarker levels was compared by Wilcoxon test.Result1.Increased expression of TNF? sR1 was associated with a decline in physical assessment of SPPB(r = 0.71,P< 0.01)and an increased linitation of IADL assessment of viability(r = 0.81,P< 0.01).2.Increased CRP serum concentrations were associated with declines in physical fitness assessed by SPPB(r=-0.73,p b 0.01).3.Increased IL-6 sR expression levels were associated with improvement in depression.(r =-0.59 P= 0.02).4.TNF-? or CRP above the median at baseline had a shorter survival period.Survival was 6.1 vs.40.2 months,P= 0.04;5.5 vs.27.6 months,P=0.04,respectively.ConclusionIn elderly patients with AML,changes in the expression levels of TNF? sR1,CRP,and IL-6 sR are related to changes in physical,emotional health and prognosis,which warrants in-depth study.