A new tool for comprehensive geriatric assessment in elderly patients with acute myeloid leukemia: a pilot study from China

BACKGROUND: Acute myeloid leukemia (AML) is a common type of hematological malignancy in elderly people. Geriatricians have developed comprehensive geriatric assessment (CGA) methods for elderly patients; however, the tools used for CGA in AML are not uniform. Thus, we aimed to validate the instrumental activities of daily living (IADL) scales, age, comorbidities (Charlson Comorbidity Index), and albumin (IACA) index, which is a new tool for CGA, in elderly patients with AML. METHODS: Patients aged ≥60 years who had been diagnosed with AML were screened for eligibility. Among the IACA low-, intermediate-, and high-risk groups, continuous variables were compared using the Mann-Whitney U test, and categorical variables were compared using χ(2) and Fisher exact tests. In addition, probabilities of overall survival (OS) were estimated using the Kaplan-Meier method. RESULTS: A total of 21, 34, and 6 patients were categorized into IACA low-risk (0 point), intermediate-risk (1–2 points), and high-risk (≥3 points) groups, respectively. The rates of relapse/progression-related mortality were 23.8%, 58.8%, and 100.0% in the IACA low-, intermediate-, and high-risk groups, respectively (χ(2) = 12.81, P < 0.001). The 2-year probabilities of OS were 47.7% (95% confidence interval [CI] 22.8%–72.6%) and 20.2% (95% CI 5.9%–34.5%) in the IACA low- and intermediate-risk groups, respectively (χ(2) = 5.99, P = 0.014), which were significantly higher than those in the high-risk group (low-risk [47.7% (95% CI 22.8%–72.6%)] vs. high-risk [0], χ(2) = 20.80, P < 0.001; intermediate-risk [20.2% (95% CI 5.9%–34.5%)] vs. high-risk [0], χ(2) = 7.56, P = 0.006; respectively). In the IACA low-risk group, the 2-year probability of OS in patients receiving induction chemotherapy (50.8% [95% CI 24.1%–77.5%]) was significantly higher than that in those receiving best supportive care (0, χ(2) = 25.74, P < 0.001). CONCLUSION: We suggest that the IACA index might be a simple and effective tool for comprehensive geriatric assessment in elderly AML patients.