Comprehensive geriatric assessment predicts azacitidine treatment duration and survival in older patients with myelodysplastic syndromes

Angela Molga; Michelle Wall; Rakchha Chhetri; Li Yan Wee; Deepak Singhal; Suzanne Edwards; Nimit Singhal; David Ross; Luen Bik To; Gillian Caughey; Sepehr Shakib; Ulrich Germing; Timothy To; Devendra Hiwase

doi:10.1016/j.jgo.2019.02.002

Comprehensive geriatric assessment predicts azacitidine treatment duration and survival in older patients with myelodysplastic syndromes

J Geriatr Oncol. 2020 Jan;11(1):114-120. doi: 10.1016/j.jgo.2019.02.002. Epub 2019 Apr 22.

Authors

Angela Molga¹, Michelle Wall², Rakchha Chhetri³, Li Yan Wee³, Deepak Singhal⁴, Suzanne Edwards⁵, Nimit Singhal⁶, David Ross⁷, Luen Bik To⁷, Gillian Caughey⁸, Sepehr Shakib⁹, Ulrich Germing¹⁰, Timothy To¹¹, Devendra Hiwase¹²

Affiliations

¹ Geriatric Division, Department of Medicine, Royal Adelaide Hospital, Adelaide, Australia; School of Medicine, University of Adelaide, Adelaide, Australia.
² Haematology Department, Royal Adelaide Hospital, Adelaide, Australia.
³ Haematology Department, Royal Adelaide Hospital, Adelaide, Australia; Cancer Research, Cancer Theme, South Australian Health and Medical Research Institute, Adelaide, Australia.
⁴ School of Medicine, University of Adelaide, Adelaide, Australia; Haematology Department, Royal Adelaide Hospital, Adelaide, Australia; Cancer Research, Cancer Theme, South Australian Health and Medical Research Institute, Adelaide, Australia.
⁵ School of Public Health,University of Adelaide,Adelaide, Australia.
⁶ School of Medicine, University of Adelaide, Adelaide, Australia; Department of Medical Oncology, Royal Adelaide Hospital Cancer Centre, Adelaide, Australia.
⁷ School of Medicine, University of Adelaide, Adelaide, Australia; Haematology Department, Royal Adelaide Hospital, Adelaide, Australia.
⁸ School of Medicine, University of Adelaide, Adelaide, Australia.
⁹ School of Medicine, University of Adelaide, Adelaide, Australia; Department of Clinical Pharmacology, Royal Adelaide Hospital, Adelaide, Australia.
¹⁰ Department of Hematology, Oncology, and Clinical Immunology, Heinrich Heine University, Düsseldorf, Germany.
¹¹ Division of Rehabilitation, Aged Care and Palliative Care, Flinders Medical Centre, Bedford Park, Australia.
¹² School of Medicine, University of Adelaide, Adelaide, Australia; Haematology Department, Royal Adelaide Hospital, Adelaide, Australia; Cancer Research, Cancer Theme, South Australian Health and Medical Research Institute, Adelaide, Australia. Electronic address: devendra.hiwase@sa.gov.au.

PMID: 31023599
DOI: 10.1016/j.jgo.2019.02.002

Abstract

Background: Treatment of older patients with myelodysplastic syndrome (MDS) is based on disease biology and performance status. Performance status, however, does not reflect increasing co-morbidities, functional dependence or psychosocial issues in older patients.

Patients and methods: This prospective study evaluated the burden of geriatric related health issues, assessed feasibility of "tailored" Comprehensive Geriatric Assessment (CGA), and compared treatment duration and survival in older patients with MDS and oligoblastic acute myeloid leukemia with and without deficits in CGA domains (n = 98).

Results: Although only 27 (28%) patients had an Eastern Cooperative Oncology Group score ≥2, 78% (n = 77) patients had deficits in at least one CGA domain. Deficits were spread across all CGA domains, including dependence for instrumental activity of daily living (iADL; n = 33, 34%). Importantly, patients who were dependent for iADL (3.7 ± 2.6 vs 12.1 ± 7.9; p = .009), had cognitive impairment (3.5 ± 2.1 vs. 10.9 ± 7.9; p = .034) or impaired mobility (3.8 ± 2.5 vs. 13.2 ± 7.6; p = .001) completed significantly less azacitidine cycles as compared to those without these deficits. Cox-proportional regression showed that iADL dependency (hazard ratio 3.37; p = .008) and higher comorbidities (hazard ratio 4.7; p < .001) were associated with poor prognosis independent of disease related factors. Poor survival of iADL dependent patients was seen in both azacitidine (6 vs 19 months; p < .001) and supportive care cohorts (26 vs 48 months; p = .01).

Conclusion: CGA detected geriatric related health issues, predicted poor survival and identified patients less likely to continue and benefit from azacitidine. Hence, CGA should be included in the treatment decision algorithm of older patients with MDS.

Keywords: Azacitidine; Comprehensive geriatric assessment; Frailty; Myelodysplastic syndrome.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Azacitidine / therapeutic use
Duration of Therapy
Geriatric Assessment*
Humans
Myelodysplastic Syndromes* / drug therapy
Prospective Studies

Substances

Azacitidine