Describing the outcomes of frail patients undergoing treatment with systemic therapies for acute myeloid leukaemia: A systematic review

Abstract

Introduction

Acute myeloid leukaemia (AML) is a disease of the older person. Due to the demands of intensive chemotherapy, there is a significant risk of over or undertreatment, leading to either iatrogenic harm or missed windows of opportunity for remission or cure. Better tools to aid clinical decision making and risk stratify patients are needed. We aimed to investigate the association between frailty and the treatment and disease-related outcomes of adults receiving systemic therapy for AML.

Materials and Methods

A systematic search of PubMed, EMBASE, CINAHL, and Web of Science databases was undertaken for studies assessing frailty (defined as multi-dimensional assessment evaluating two or more geriatric relevant domains or usage of a validated geriatric assessment screening tool) in the setting of adults undergoing systemic therapy for AML.

Results

We identified 6,644 publications, 16 of which met inclusion criteria for extraction. The most commonly described outcomes were overall survival (OS) (n = 12), mortality (n = 8), response rate (n = 6), and high grade toxicity (n = 5). Eleven studies correlated frailty with treatment outcomes: frailty was predictive of lower OS (n = 5), higher mortality (n = 3), and more high grade toxicity (n = 1). OS in particular retained this relationship when controlling for variables such as molecular markers and performance status. Significant heterogeneity in outcome reporting and frailty assessment precluded meta-analysis. Included studies were generally of moderate quality.

Discussion

Frailty was predictive of poorer outcomes in patients with AML distinct from and complimentary to traditional disease prognostic schema. Routine implementation of frailty assessment could represent an important tool to risk stratify patients and improve clinical decision making.