TABLE 2.

Multiparameter Assessments and Prognostic Models of Fitness for Older Patients With AML

Assessment/reference No. of patients	Factors				Prognostic model
	Age	PS	Comorbidities	Disease characteristics
Kantarjian 2006 20 N = 998	≥75 y	ECOG PS >2 (CR, OS), ≥2 (8‐wk mortality)	Creatinine >1.3 mg/dL Antecedent hematologic disorder ≥6 months (CR), ≥12 months (OS)	Unfavorable/complex karyotype WBC ≥25 × 109/L LDH >600 U/L Treatment outside laminar airflow room	Patients with ≥3 factors have CR rates <20%, 8‐wk mortality >50%, and 1‐y survival <10%
Rollig 2010 28 N = 909	>65 y (3 points)			Cytogenetic risk‐independent risk factor of OS NPM1 mutation (−2 points) CD34 expression >10% (2 points) WBC >20 × 109/L (2 points)	Four prognostic profiles: Favorable cytogenetics Good intermediate (intermediate cytogenetics and score ≤3) Adverse intermediate (intermediate cytogenetics and score >3) High‐risk cytogenetics
Krug 2010 29 N = 1406; validation cohort, n = 801	≥60 y			Cytogenetic and molecular risk Body temperature Hb Platelets Fibrinogen LDH De novo vs secondary AML	All patients received IC Calculated scores using disease characteristics, predicted probability of CR and early death
Klepin 2013 26 N = 74	≥60 y	ECOG PS (≤1 = good; >1 = poor) Physical function: Pepper Assessment Tool for Disability Self‐reported prediagnosis and time of treatment Grip strength SPPB	Cognitive function: 100‐point 3MS exam Depressive symptoms: 20‐item 60‐point CES‐D and HCT‐CI Distress Thermometer: 0–10 point rating	Cytogenetic risk Baseline Hb WBC LDH Prior MDS	OS associated with cytogenetic risk, prior MDS, baseline Hb OS associated with poor cognitive function (3MS <77) and low physical function (SPPB <9) OS was not associated with age, ECOG PS, depression, or distress
Deschler 2013 27 N = 195	≥60 y	KPS (0–100) ADLs (Barthel Index, 0–100, and IADLs, 0–8) Get‐up and Go Test	Charlson Comorbidity Index HCT‐CI Depression: GDS MMSE QOL: EORTC QLQ‐C30	BM blasts % Cytogenetics IPSS in MDS WBC Hb LDH Creatinine Creatinine clearance Albumin	ADL Barthel Index <100; KPS <80, and increased fatigue (≥50 by EORTC QLQ‐C30) were highly predictive of OS regardless of treatment group (BSC, HMA, IC) and similar to disease factors such as poor‐risk cytogenetics and BM blasts ≥20%
Geriatric Assessment in Hematology (GAH) Scale Bonanad 2015, 30 dela Rubia 2015 31 N = 349; MDS/AML, n = 116 (33.2%)	≥65 y	Gait speed (<0.8 m/s) ADL (3 items from VES‐13; needs help in ≥1 area) Subjective health status (VES‐13; response of poor or fair)	Number of drugs (≥5) Mood (CES‐D; frequently depressed, 3–7 d/wk) Nutrition: MNA‐SF; ≤8 Mental status: SPMSQ; ≥3 errors Prognostic Index for 4‐Year Mortality in Older Adults, including diabetes, cancer, lung disease, heart failure, BMI, smoking (≥3)		Scale score ranges from 0–8 with 1 point attributed for each dimension based on cutoff point (shown in parentheses) Correlated with ECOG PS and KPS except for the comorbidities domain Increasing GAH score group (≤1, 2–6, >6) was predictive of survival

Abbreviations: 3MS, Modified Mini‐Mental State Examination; ADLs, activities of daily living; AML, acute myeloid leukemia; BM, bone marrow; BMI, body mass index; BSC, best supportive care; CES‐D, Center for Epidemiologic Studies–Depression Scale; CR, complete remission; ECOG, Eastern Cooperative Oncology Group; EORTC QLQ‐C30, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30; GDS, Geriatric Depression Scale; Hb, hemoglobin; HCT‐CI, Hematopoietic Cell Transplantation–Specific Comorbidity Index; HMA, hypomethylating agent; IADLs, instrumental activities of daily living; IC, induction chemotherapy; IPSS, International Prognostic Scoring System; KPS, Karnofsky performance status; LDH, lactate dehydrogenase; MDS, myelodysplastic syndrome; MMSE, Mini‐Mental State Examination; MNA‐SF, Mini‐Nutritional Assessment; OS, overall survival; PS, performance status; QOL, quality of life; SPPB, Short Physical Performance Battery; SPMSQ, Short Portable Mental Status Questionnaire; VES‐13, Vulnerable Elders Survey; WBC, white blood cell.