Objectively measured physical function predicts mortality in older adults with acute myeloid leukemia treated by lower-intensity therapy: A prospective cohort study.

INTRODUCTION

In older adults with acute myeloid leukemia (AML) treated with intensive chemotherapy, the Short Physical Performance Battery (SPPB) and the short form of the Geriatric Depression Scale (SGDS-K) predict survival outcomes. However, their role in lower-intensity therapy remains unclear. We evaluated their prognostic role in older adults with AML treated with hypomethylating agents (HMA) with or without venetoclax (VEN).

MATERIALS AND

METHODS

In this single-center, prospective cohort study, patients with AML aged ≥60 years receiving HMA or HMA/VEN therapy were included. SPPB and SGDS-K scores were assessed before treatment, and their associations with overall survival (OS), other outcomes, and prognostic utility were analyzed.

RESULTS

From November 2016 to June 2023, 124 (HMA: N = 52, HMA/VEN: N = 82) patients were enrolled. In the HMA group, there were 32 males and 20 females, while in the HMA/VEN group, there were 45 males and 37 females. The median follow-up duration was 62.1 months for the HMA group and 22.4 months for the HMA/VEN group. Impaired physical function (SPPB <10) was significantly associated with worse OS in patients receiving HMA/VEN (median 5.4 months [2.5-9.4] vs. 16.4 months [8.7-not reached], p = 0.004), but not in HMA-treated patients (median 7.8 months [3.3-17.7] vs. 8.6 months [2.4-22.8], p = 0.92). The association between impaired SPPB and OS in the HMA/VEN group remained statistically significant after adjusting for age and performance status in multivariable analysis. Impairment on the SGDS-K showed no association with OS in either group. In the HMA/VEN group, the addition of SPPB to the existing treatment-related mortality score model improved the prediction of early death, increasing the area under the receiver operating characteristic curve (AUC) from 0.659 to 0.804 (p = 0.02). Incorporation of SPPB into the Wheatley index also improved the AUC from 0.685 to 0.783, though it did not reach statistical significance (p = 0.06).

DISCUSSION: This study highlights the prognostic role of objectively measured physical function on survival in older adults with AML treated with HMA/VEN therapy. Further research for independent verification of our findings is warranted, and incorporating objectively measured physical function into treatment decision-making could be considered.

TRIAL REGISTRATION: This study is registered in the Clinical Research Information Service, CRIS, #KCT0002172, and #KCT0002261.