“Pretreatment geriatric assessment in older adults with acute myeloid leukemia is feasible, can identify several functional impairments, and [can] guide the selection of treatment intensity,” resulting in low rates of early mortality, according to Vijaya R. Bhatt, MBBS, MS, of the University of Nebraska Medical Center, Omaha, and colleagues.1 These findings from the fully accrued investigation of a single-center phase II trial, which were published in the American Journal of Hematology, appear to support those of the previous preplanned interim analysis.2
Population and Treatment Strategy
A total of 73 patients with acute myeloid leukemia or a high-grade, treatment-related myeloid neoplasm who were aged at least 60 years underwent geriatric assessments, including measures of comorbidity burden (Hematopoietic Cell Transplantation Comorbidity Index: score ≥ 3, 55%), self-reported physical function (Katz Activities of Daily Living Index: score ≤ 5, 29%; Lawton Instrumental Activities of Daily Living Index: score ≤ 7, 22%), objective physical function (Short Physical Performance Battery: score ≤ 9, 70%), and cognitive function (Montreal Cognitive Assessment: score ≤ 25, 64%). Any available genetic testing results were used for risk stratification into three categories: good (18%), intermediate (22%), and adverse (60%).
Pretreatment geriatric assessment in older adults with acute myeloid leukemia is feasible, can identify several functional impairments, and [can] guide the selection of treatment intensity.— VIJAYA R. BHATT, MBBS, MS, AND COLLEAGUES
Tweet this quote
Patients who scored well on all geriatric assessment domains received intensive chemotherapy (good or intermediate risk: anthracycline plus cytarabine–based regimen [n = 4]; adverse risk: liposomal daunorubicin/cytarabine [CPX-351; n = 4]). Low-intensity chemotherapy (azacitidine or decitabine and venetoclax: n = 43; decitabine or azacitidine alone [before venetoclax approval]: n = 18; other: n = 4) was administered in those who were deemed unfit or who had adverse-risk disease not meeting the indication for CPX-351. The median time from enrollment to the initiation of therapy was 1 day (range, 0–13 days).
Broad eligibility criteria enabled enrollment of a population representative of those treated in real-world practices: 45% were aged at least 70 years, 57% had at least two comorbidities, 27% had a history of solid malignancies, and 74% had impairments in at least two geriatric assessment domains. A total of 32% and 45% of patients resided in rural areas and were comanaged with community oncologists, respectively.
Outcomes
A total of 52% of patients achieved either complete remission (40%) or complete remission with incomplete count recovery (12%) as their best response to study treatment. Other responses included morphologic leukemia-free state (2.8%) and resistant disease (35.6%); additionally, 9.6% were not evaluable. The probabilities of achieving complete remission and complete remission with incomplete count recovery were 69.2%, 56.3%, and 45.5% for patients with good-, intermediate-, and adverse-risk disease, respectively. It was 50% for fit patients (treated with intensive chemotherapy) and 52.3% for their unfit counterparts.
With a median follow-up of 12 months, the mortality rate was 6.8% (95% confidence interval [CI] = 3.0%–15.1%) at 30 days and 21.9% (95% CI = 14.0%–32.7%; historical institutional benchmark, 40%) at 90 days. The 1-year Kaplan-Meier estimated overall survival rate was 45.9% (95% CI = 35.6%–59.3%). The 30- and 90-day mortality rates were 0% and 7.7%, respectively, for the population with good-risk disease; of 13 such patients, 8 lived for 1 year, and 6 lived for 2 years.
For fit and unfit patients, the mortality rates were 0% and 7.7% at 30 days and 12.5% and 23.1% at 90 days, respectively. The 1-year overall survival rate was 42.9% in fit patients and 46.3% in their unfit counterparts. Acute myeloid leukemia was reported as the cause of death less frequently among fit vs unfit patients (40% vs 51%).
Allogeneic stem cell transplantation was subsequently performed in 41.1% of the population. A total of 75% and 37% of fit and unfit patients, respectively, underwent this procedure.
“Our study results demonstrate the success of broad eligibility criteria and academic-community collaboration in expanding access to clinical trials and in enrolling older adults who have multimorbidity or reside in rural areas,” the investigators concluded. “In this context, our approach to personalize selection of treatment intensity in older adults with acute myeloid leukemia, and our research design considerations, including broad eligibility criteria and collaboration with community oncology centers, can serve as a model for future trials that aim to answer issues specific to treatment selection in older adults with acute myeloid leukemia or other hematologic malignancies.”
They added, “While geriatric assessment results can provide an objective model to determine fitness for intensive chemotherapy, a randomized trial is necessary to confirm whether integrating geriatric assessment and genetic tests to select treatment intensity improves survival over the traditional approach.”
DISCLOSURE: Dr. Bhatt reported participation/membership in the Safety Monitoring Committee for Protagonist and National Comprehensive Cancer Network Acute Myeloid Leukemia panel, as well as an Associate Editor role for Current Problems in Cancer and as a Contributor for BMJ Best Practice. He also reported consulting fees from Imugene, Sanofi, and Taiho, as well as institutional research funding from Cynata Therapeutics, MEI Pharma, Actinium Pharmaceutical, Sanofi U.S. Services, AbbVie, Pfizer, Incyte, Jazz, and National Marrow Donor Program, and institutional drug support from Chimerix for a trial. For full disclosures of the other study authors, visit onlinelibrary.wiley.com.
REFERENCES
- Bhatt VR, Wichman CS, Koll TT, et al: A phase II trial of geriatric assessment-guided selection of treatment intensity in older adults with AML. Am J Hematol 100:1163-1172, 2025.
- Bhatt VR, Wichman C, Al-Kadhimi ZS, et al: Integrating geriatric assessment and genetic profiling to personalize therapy selection in older adults with acute myeloid leukemia. J Geriatr Oncol 13:871-874, 2022.
EXPERT POINT OF VIEW
Filipe Coutinho, MD, a medical oncologist with postgraduate specializations in geriatrics and palliative care from the Local Health Unit of Medio Ave in Portugal, shared with The ASCO Post the following broader context for geriatric assessments for patients with acute myeloid leukemia:
“The phase II study by Bhatt et al demonstrates that pretreatment geriatric assessment is both feasible to integrate into the management of older adults with acute myeloid leukemia and capable of meaningfully informing treatment intensity.1 In their cohort, nearly three-quarters of patients exhibited impairments in two or more geriatric assessment domains, underscoring that chronological age alone is an incomplete surrogate for physiologic reserve. Aligning therapy with objectively assessed functional, cognitive, and comorbidity profiles—while also incorporating cytogenetic risk stratification—was associated with remarkably low early mortality (6.8% at 30 days; 21.9% at 90 days) and encouraging survival outcomes.
Recent work from the Young International Society of Geriatric Oncology further substantiates geriatric assessment’s value in acute myeloid leukemia. Impairments in physical performance (eg, Short Physical Performance Battery ≤ 9) or cognitive function (eg, Montreal Cognitive Assessment ≤ 26) have been independently linked to poorer overall survival and greater risk of treatment-related toxicity.2 These findings highlight that geriatric assessment provides prognostic information that is not captured by traditional performance status measures and that its domains are dynamic—potentially evolving over the course of therapy—underscoring the importance of longitudinal rather than single-point evaluations.
Filipe Coutinho, MD
The study by Bhatt et al reflects several key principles of geriatric oncology.1 Geriatric assessment identifies vulnerabilities often overlooked by conventional assessments, allowing clinicians to better anticipate toxicity, tailor supportive care, and avoid both overtreatment and undertreatment. Although similar response patterns were observed across different treatment intensities, these observations should be interpreted with caution and reinforce the concept that physiologic fitness exists on a continuum and requires individualized assessment. Equally important is the study’s broad eligibility criteria and community–academic collaboration: enrolling patients aged 70 and older, those with multimorbidity, and individuals from rural areas enhances real-world relevance and offers a pragmatic framework for future hematologic malignancy trials.
To build on this work, future studies should systematically evaluate a broader set of geriatric assessment domains, including nutritional status, psychological health, geriatric syndromes, and social support, to examine their relationships with both efficacy and treatment tolerance.
From a geriatric oncology perspective, these results make a strong case for embedding geriatric assessment as a routine component of acute myeloid leukemia evaluation rather than treating it as an adjunct. Beyond guiding therapy selection, geriatric assessment uncovers patient-specific vulnerabilities that can be proactively addressed to optimize treatment tolerance, preserve functional independence, and improve outcomes.
By enrolling a diverse patient population and fostering community–academic partnerships, Bhatt et al provide a model for improving the inclusivity and applicability of clinical trials. Moving forward, integrating geriatric assessment with molecular profiling and testing geriatric assessment–guided interventions in randomized settings can extend precision medicine beyond genomics to encompass functional, cognitive, and psychosocial dimension, reminding us that, for older adults with acute myeloid leukemia, truly personalized therapy begins with understanding the host as well as the disease.”
DISCLOSURE: Dr. Coutinho reported receiving consulting fees from AstraZeneca Portugal. He reported no other conflicts of interest.
REFERENCES
- Bhatt VR, Wichman CS, Koll TT, et al: A phase II trial of geriatric assessment-guided selection of treatment intensity in older adults with AML. Am J Hematol 100:1163-1172, 2025.
- Ciccone AS, Thibaud V, Pugh K, et al: Geriatric assessment in older adults with acute myeloid leukemia: A Young International Society of Geriatric Oncology narrative review. J Geriatr Oncol 16:102254, 2025.
