Parameters detected by geriatric and quality of life assessment in 195 older patients with myelodysplastic syndromes and acute myeloid leukemia are highly predictive for outcome.

Articles MDS published on April 21, 2014

Deschler B, et al. Parameters detected by geriatric and quality of life assessment in 195 older patients with myelodysplastic syndromes and acute myeloid leukemia are highly predictive for outcome. Haematologica. 2013;98:208-216.

A wide range of treatment options of varying intensity are available for older patients with myelodysplastic syndrome (MDS) or acute myeloid leukemia (AML). The selection of treatment usually takes into account both disease-specific parameters and patient-specific variables (such as age, performance status and comorbidities), however, patient-related functional parameters likely considered by the physician have not been sufficient characterized or quantified. The aim of these European investigators was to prospectively apply a multidimensional geriatric and quality of life assessment to elderly patients, incorporating factors aside from established disease-specific variables, and to assess its prognostic value. The population included 195 patients ≥60 years of age, grouped according to treatment intensity. Deschler, et al., used 8 instruments to evaluate activities of daily living, depression, mental functioning, mobility, comorbidities, Karnofsky Index and quality of life.

To rule out the confounding factors of treatment, the investigators focused on 107 patients undergoing non-intensive treatment only, to identify those variables that were independent patient-related prognostic parameters suited to the development of a prognostic model. In the multivariate analysis of overall survival, impairments in performance status and activities of daily living along, the symptom item “fatigue” from the quality of life instrument, poor-risk cytogenetics/IPSS and bone marrow blasts ≥20% were retained as independent prognostic factors. The prognostic effect of the assessment tool was weakest among the “fitter and younger” intensively treated patients.

“The basic information reflecting a patient’s functionality and quality of life strongly indicate vulnerability and complement the key clinical parameters that have until now influenced treatment decision-making. This study supports the systematic, prospective use of geriatric and quality of life assessments as important additional tools in clinical evaluations,” the authors concluded.

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Last modified: April 21, 2014

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