Objectively measured physical function predicts mortality in older adults with acute myeloid leukemia treated by lower-intensity therapy: A prospective cohort study.

Introduction: In older adults with acute myeloid leukemia (AML) treated with intensive chemotherapy, the Short Physical Performance Battery (SPPB) and the short form of the Geriatric Depression Scale (SGDS-K) predict survival outcomes. However, their role in lower-intensity therapy remains unclear. We evaluated their prognostic role in older adults with AML treated with hypomethylating agents (HMA) with or without venetoclax (VEN).

Materials And Methods: In this single-center, prospective cohort study, patients with AML aged ≥60 years receiving HMA or HMA/VEN therapy were included. SPPB and SGDS-K scores were assessed before treatment, and their associations with overall survival (OS), other outcomes, and prognostic utility were analyzed.

Results: From November 2016 to June 2023, 124 (HMA: N = 52, HMA/VEN: N = 82) patients were enrolled. In the HMA group, there were 32 males and 20 females, while in the HMA/VEN group, there were 45 males and 37 females. The median follow-up duration was 62.1 months for the HMA group and 22.4 months for the HMA/VEN group. Impaired physical function (SPPB <10) was significantly associated with worse OS in patients receiving HMA/VEN (median 5.4 months [2.5-9.4] vs. 16.4 months [8.7-not reached], p = 0.004), but not in HMA-treated patients (median 7.8 months [3.3-17.7] vs. 8.6 months [2.4-22.8], p = 0.92). The association between impaired SPPB and OS in the HMA/VEN group remained statistically significant after adjusting for age and performance status in multivariable analysis. Impairment on the SGDS-K showed no association with OS in either group. In the HMA/VEN group, the addition of SPPB to the existing treatment-related mortality score model improved the prediction of early death, increasing the area under the receiver operating characteristic curve (AUC) from 0.659 to 0.804 (p = 0.02). Incorporation of SPPB into the Wheatley index also improved the AUC from 0.685 to 0.783, though it did not reach statistical significance (p = 0.06).

Discussion: This study highlights the prognostic role of objectively measured physical function on survival in older adults with AML treated with HMA/VEN therapy. Further research for independent verification of our findings is warranted, and incorporating objectively measured physical function into treatment decision-making could be considered.

Trial Registration: This study is registered in the Clinical Research Information Service, CRIS, #KCT0002172, and #KCT0002261.