Management of hematologic conditions including MDS and acute leukemias are particularly challenging among older adults due to variable coexisting comorbid conditions and functional status which can impact treatment tolerance and benefit. Clinical trials which individualize risk assessment for older patients and capture patient-centric outcomes, such as quality of life, are needed to optimize management for each older adult.
- Acute Myeloid Leukemia and Myelodysplastic Syndromes in Older Adults: This Journal of Clinical Oncology review article highlights special issues related to older adults diagnosed with MDS and acute myeloid leukemia including differences in tumor biology and treatment outcomes. Available evidence specific to older adults is reviewed highlighting the role of individualized patient assessment accounting for the biology of disease, the patients assessed fitness, and goals of care.
- Efficacy of Azacitidine Compared With That of Conventional Care Regimens in the Treatment of Higher-Risk Myelodysplastic Syndromes: A Randomized, Open-Label, Phase III Study: This clinical trial published in Lancet Oncology demonstrated a survival advantage for treatment with azacitidine among patients with higher risk MDS, many of whom are older. This study supported results from prior trials establishing azacitidine as a standard of care for treatment of higher risk MDS.
- Impact of Azacitadine on the Quality of Life of Patients With Myelodysplastic Syndromes Treated in a Randomized Phase III Trial: A Cancer and Leukemia Group B study: This study published in the Journal of Clinical Oncology reported on the quality of life benefits (in addition to improved progression free survival) of azacitidine treatment among patients enrolled on a randomized clinical trial. Demonstrating improvements in quality of survivorship is critically important for older adults who are considering the challenges of continuous chemotherapy in the non-curative setting.
- Results of Treatment with Azacitidine in Patients ≥ 75 Years Included in the Spanish Registry of Myelodysplastic Syndromes: This study published in the journal Leukemia and Lymphoma is one of the few studies to specifically look at the clinical experience and outcomes of adults over age 75 who were treated with azacitidine for MDS. The results support a benefit from treatment among patients with high risk MDS in this age group who are frequently under-represented on clinical trials.
- Patient-Related Factors Independently Impact Overall Survival in Patients With Myelodysplastic Syndromes: An MDS-CAN Prospective Study: This British Journal of Haematology article presents data supporting the importance of assessing frailty among older adults with MDS. This observational study enrolled over 400 adults with an average age of 73 years and demonstrated that a simple 9 point clinical frailty rating was prognostic of overall survival in addition to assessment of comorbidity.
- Geriatric Assessment Predicts Survival for Older Adults Receiving Induction Chemotherapy for Acute Myelogenous Leukemia: This study published in Blood demonstrated the utility of performing geriatric assessment prior to intensive chemotherapy treatment for older adults with newly diagnosed acute myeloid leukemia. In this study both objectively measured physical performance (tested by walking speed, balance testing, chair stands) and cognitive function were independently associated with overall survival. The results suggest that objectively assessing physical function and cognition adds information to usual care and can help identify patients who are fit versus vulnerable for a given therapy.
- Hematopoietic Stem Cell Transplantation for Hematologic Malignancies in Older Adults: Geriatric Principles in the Transplant Clinic: Because of the high rate of morbidity from autologous and allogeneic hematopoietic stem cell transplantations, which increases with age, doctors have traditionally not used these treatment strategies with older patients. But in this Journal of the National Comprehensive Cancer Network article, authors propose that the decision to conduct hematopoietic stem cell transplantations should be based on comorbidities and functional status, rather than age alone, and that a comprehensive geriatric assessment can be helpful in this treatment decision process.