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4218 Stratification Using ECOG, ADL and HCT-CI Scales, but Not CGA Enables Identifying Elderly AML Patients Fit for Intensive Chemotherapy – a Multicenter Study from Polish Adult Leukemia Group

Program: Oral and Poster Abstracts
Session: 613. Acute Myeloid Leukemias: Clinical and Epidemiological: Poster III
Hematology Disease Topics & Pathways:
Clinical Practice (Health Services and Quality)
Monday, December 11, 2023, 6:00 PM-8:00 PM

Bozena Katarzyna Budziszewska, MD, PhD1*, Michał Łomiak, MD1*, Joanna Barankiewicz, MD, PhD1*, Elzbieta Patkowska, MD, PhD1*, Grzegorz Helbig, MD, PhD2*, Lukasz Bolkun, MD, PhD3*, Anna Irga-Staniukiewicz, MD4*, Anna Kiżewska4*, Agnieszka Piekarska, MD, PhD4*, Anna Koclęga, MD2*, Agnieszka Pluta, MD, PhD5*, Marta Kuydowicz, MD5*, Sylwia Kościółek- Zgódka, MD6*, Edyta Cichocka, MD, PhD7*, Agata Malenda, MD, PhD8*, Karol Wójcik, MD9*, Tomasz Gromek, MD, PhD10*, Piotr Małecki, MD11*, Sebastian Grosicki, MD, PhD11*, Agnieszka Wierzbowska, M.D., Ph.D.12 and Ewa Lech-Maranda, MD, PhD13*

1Department of Hematology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
2Department of Hematology and Bone Marrow Transplantation, Medical University of Silesia, Katowice, Poland
3Medical University of Bialystok, Bialystok, Poland
4Department of Hematology and Transplantology, Medical University of Gdansk, Gdansk, Poland
5Department of Hematology and Transplantology, Copernicus Memorial Hospital in Lodz, Department of Hematology, Medical University of Lodz, Lodz, Poland
6Holy Cross Cancer Center, Kielce, Poland
7Nicolaus Copernicus General Hospital, Torun, Poland
8Faculty of Medicine, Lazarski University, Warsaw, Poland
9Hematology Department, Rydygier Memorial Hospital, Krakow, Poland
10Department of Hematooncology and Bone Marrow Transplantation, Medical University of Lublin, Lublin, Poland
11Department of Hematology and Cancer Prevention, Faculty of Health Sciences, Medical University of Silesia, Katowice, Poland
12Department of Hematology and Transplantology, Multidisciplinary Provincial Centre of Traumatology and Oncology Nicolas Copernicus in Lodz, Lodz, Poland
13Institute of Hematology and Transfusion Medicine, Warsaw, Poland

Introduction: A key part of decision-making in older AML patients is an insightful clinical assessment before qualification for treatment with intensive chemotherapy (IC). It was demonstrated that among the patients initially deemed “fit” for IC, there are vulnerable patients who experience greater treatment toxicity and have poorer outcomes. Comprehensive geriatric assessment (CGA) is a well-recognized tool for identifying such patients. However, due to its time-consuming nature, it is not commonly used. A number of other prognostic models exist, but none of them enable fast and optimal identification of patients eligible for IC.

Aim: In this prospective observational study our group aimed to I) assess clinical outcomes of elderly AML patients who were stratified by Eastern Cooperative Oncology Group Performance Status (ECOG PS), Hematopoietic Cell Transplantation Comorbidity Index (HCT-CI), Activity of Daily Living (ADL) scales and received IC and II) evaluate the predictive and prognostic value of CGA components.

Material and methods: AML patients aged between 60 and 75 were considered fit for IC if they met all 3 stratification criteria: ECOG PS<2 and HCT-CI<3 and ADL=6. IC regimens included daunorubicin and cytarabine (DA) or daunorubicin, cytarabine and cladribine (DAC) followed by 2 consolidation cycles according to local references. CGA was performed by a qualified medical professional before treatment initiation. CGA included Instrumental Activities of Daily Living Score (iADL), timed up and go test (TUG), geriatric depression scale (GDS), Mini-mental scale Examination (MMSE) and Mini Nutritional Assessment (MNA). The correlations between CGA and complete response (CR) rate were determined by Chi-square test or Fisher`s exact test. The Kaplan-Meier analysis and log-rank test were used to compare relapse-free survival (RFS) and overall survival (OS)

Results: In total, 85 patients with a median age of 65 years [IQR:63.5-69.0] and slight male predominance (53%) were included in the study. Most patients had HCT-CI score <2 (71.8%). Secondary AML was diagnosed in 23.5% of patients, and most patients had intermediate (32.9%) or adverse (37.6%) ELN cytogenetic risk. Fifty-five (58.8%) patients achieved CR after induction. Median OS reached 16.0 months [95% CI: 11.0-21.00] with median RFS 15.3 months [95% CI: 12.1-18.4]. No significant difference in CR rate (p=0.451), OS (p=0.484) or RFS (p=0.529) was demonstrated between DA or DAC groups. Regardless of induction regimen, patients with CR presented significantly improved OS (p=0.015 for DA, p=0.029 for DAC) compared with non-CR patients. None of the CGA components was shown to influence the CR rate, OS or RFS.

Conclusions: In patients aged 60–70 years with AML, stratification by ECOG, ADL, and HCT-CI is an effective tool for qualifying patients for intensive chemotherapy. Comprehensive geriatric assessment does not improve identification of vulnerable patients in this group.

Disclosures: Budziszewska: Janssen: Honoraria; Servier: Honoraria; Abbvie, Celgene/BMS, GSK, Novartis: Membership on an entity's Board of Directors or advisory committees, Other: Speaker. Helbig: AbbVie: Other: investigator on AbbVie-sponsored clinical trials; Gilead: Honoraria; Novartis: Speakers Bureau; GSK: Honoraria; Swixx: Honoraria. Bolkun: Abbvie: Speakers Bureau. Piekarska: Astellas: Honoraria; Celgen/BMS: Honoraria; AstaZeneca: Membership on an entity's Board of Directors or advisory committees; Novartis: Honoraria; Pfizer: Honoraria; SOBI: Membership on an entity's Board of Directors or advisory committees. Pluta: Abbvie: Honoraria; Astellas: Honoraria; Celgene/BMS: Honoraria; Jazz Pharmaceuticals (Swixx): Honoraria, Research Funding; Pfizer: Honoraria. Kościółek- Zgódka: ABBVIE: Honoraria. Wierzbowska: Astellas: Consultancy, Honoraria; Abbvie: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; JazzPharmaceuticals/swixx: Honoraria; Celgene/BMS: Honoraria; Servier: Honoraria; Novartis: Honoraria; Gilead: Honoraria; Pfizer: Honoraria.

*signifies non-member of ASH