ASH 2025 | Geriatric assessment-guided treatment in older AML: cognitive and functional predictors

We conducted a Phase 2 trial at the University of Nebraska Medical Center. This was perhaps the first trial where we utilized geriatric assessment to guide treatment intensity. How do we select older adults with leukemia for intensive versus low-intensity chemotherapy is not clearly answered. So we wanted to provide an answer in terms of an objective criterion for fitness for intensive chemotherapy and use geriatric assessment results to guide the intensity of chemotherapy. So we enrolled 73 older adults with AML. We performed geriatric assessment at baseline, as well as follow-up. At baseline, we found that patients had a very high burden of comorbidity, as well as multiple functional impairments, both in terms of physical function impairment, cognitive impairment, and so on. So in this population with a high comorbidity burden and functional impairment, we were able to demonstrate that we could utilize a personalized approach to treatment selection. And that manuscript was published just recently in the American Journal of Hematology. In this abstract, we looked at whether geriatric assessment findings at baseline correlate with mortality at one year and we found that two factors correlate with survival. One is impairment in cognition as measured by the Montreal Cognitive Assessment. So older adults who have intact cognition did better than older adults with impaired cognition. And then the second thing we looked at is whether it makes a difference if an older adult has more than one functional impairment. So we looked at survival in terms of the number of impairments and we found that older adults who had four or more impairments did significantly worse than older adults who had zero to three impairments. We did not see a lot of difference in older adults who received, who had zero, one, or two versus three impairments. So a cutoff of four was used. So the more impairment an older adult has at the time of diagnosis of acute myeloid leukemia, the worse survival is expected. This has not, in terms of this cumulative burden of impairment, there have been other studies which have looked at it from a different perspective, looking at the deficit accumulation index. But in terms of the number of impairments at the time of diagnosis, this is one of the first studies that have looked at how older adults do if they have multiple functional impairments. And this also opens an opportunity to provide supportive care tailored based on impairments we detect at the time of diagnosis.

This transcript is AI-generated. While we strive for accuracy, please verify this copy with the video.