Background
Treatment of older persons with Acute Myeloid Leukaemia (AML) presents a dilemma: intensive treatment carries significant risk of toxicity, but undertreatment can miss opportunities for remission or cure. Geriatric assessment (GA) to quantify frailty can improve outcomes in cancer care but data in AML is lacking. We conducted a systematic literature review to assess how the outcomes of frail patients with AML receiving systemic therapy differ from their fitter counterparts.
Methods
Two reviewers independently assessed papers from searches on PubMed, EMBASE, CINAHL and Web of Science. Studies were included if they were prospective, published in English, included patients aged >18 years with AML undergoing systemic therapy and conducted GA (either using a validated GA screening tool or assessments covering >2 geriatric domains). Frailty was defined as impairment on GA below reference ranges defined by individual papers. Baseline patient parameters, GA format and treatment outcomes were analysed. Quality was assessed using the Cochrane Risk of Bias 2 tool and Newcastle-Ottawa Scale.
Results
6644 studies were eligible for inclusion. 6628 studies were excluded after screening, leaving 16 studies for analysis. Studies were generally of low-moderate quality. 13 studies included patients undergoing intensive chemotherapy, seven undergoing low intensity therapies and two on best supportive care. Of ten studies exploring GA prognostic value, nine studies found GA was predictive of treatment outcomes: overall survival (n=7), mortality (n=3) and high grade toxicity (n=1). This association persisted in the majority of studies after controlling for traditional disease risk factors such as age, comorbidities and molecular risk factors. One study found GA was not predictive of outcomes.
Conclusion
Frailty assessment has prognostic utility in AML complimentary to traditional disease risk factors. Whether routine implementation of GA can improve treatment outcomes in AML is unclear and represents a potential target of future research.