BOSTON—Acute myeloid leukemia (AML) is a particularly aggressive blood cancer that is most successfully treated with intensive chemotherapy. As the average age at diagnosis is 68, patients diagnosed with the disease are often too frail to withstand potentially curative treatment with induction regimens. Previous studies have demonstrated that treating elderly patients with AML without first assessing their frailty reduces survival rates.
Despite the risk, “frailty assessments are rarely done in busy oncology clinics, calling for more innovative tools to evaluate health status,” noted Boston-based researchers in a presentation at the 64th American Society of Hematology Annual Meeting in New Orleans on Dec. 11. The team, led by Michelle Hyunju Lee, MD, of the Boston University School of Medicine, included multiple researchers from the VA Boston Healthcare System.1
Because no quick and accurate tool for assessing frailty in AML patients is currently widely used, the researchers sought to determine whether the Veterans Affairs Frailty Index (VA-FI) could meet the need for evaluating AML patients. VA-FI had been initially developed and validated as a tool for assessing frailty in veterans with lung cancer and multiple myeloma.
The retrospective study analyzed records from 1,166 veterans newly diagnosed with AML between Jan. 1, 2012, and April 1, 2022. “The VA-FI measures frailty via diagnostic and procedure codes that represent 31 aging-related health deficits spanning morbidity, function, cognition, sensory, and other, with scores computed as the proportion of potential health deficits that are present in each veteran,” the team explained. Veterans with VA-FI score less than or equal to 0.2 were categorized as non-frail, while those with higher scores were considered frail.
The team evaluated the outcomes of veterans determined to be frail (62%) vs. nonfrail veterans (38%). Induction regimens in the study were anthracycline-based or venetoclax-based combinations. Nonfrail veterans were more likely to receive an anthracycline-based regimen rather than one based on venetoclax than frail veterans.
Median follow-up was 252.5 days, at which point 77% of the veterans had died. Moderate to severely frail veterans (VA-FI greater than 0.3) had a median survival of 179 days compared to 306 days for mildly frail veterans (VA-FI between 0.2 and 0.3) and 417 days for nonfrail veterans. The risk of death compared to nonfrail veterans was 1.38 times higher in mildly frail patients and 1.85 times higher in moderately to severely frail veterans. The association between the VA-FI score and survival persisted after adjustment for age, gender, race/ethnicity, region, rurality, European LeukemiaNet 2017 risk classification, bone marrow blast percent and treatment-related variables.
The team observed that frailty was very common among veterans with newly diagnosed and treated AML. The VA-FI score predicted survival in veterans with AML, independent of age, sociodemographics, markers of disease risk, induction therapy regimen and transplantation status. As a result, it could be used to assess outcomes of therapies in frail veterans with AML compared to clinical trial populations. The tool may also help oncologists readily measure frailty in patients, providing greater insight into the patient’s prognosis and assisting in treatment decisions.
- Lee MH, La J, Brophy M, Do NV, Driver JA, Tuck DP, Fillmore NR, Dumontier C. Baseline Correlates of Frailty and Its Association with Survival in U.S. Veterans with Newly Diagnosed and Treated Acute Myeloid Leukemia. Abstract 3624. 2022 ASH Annual Meeting. Dec. 11, 2022.