Abstract

Treatment choice according to the individual conditions remains challenging, particularly in older patients with acute myeloid leukemia (AML) and high risk myelodysplastic syndrome (MDS). The impact of performance status, comorbidities, and physical functioning on survival is not well defined for patients treated with hypomethylating agents. Here we describe the impact of performance status (14% ECOG performance status 2), comorbidity (40% HCT-comorbidity index ≥ 2), and physical functioning (41% short physical performance battery < 9 and 17% ADL index < 6) on overall survival (OS) in 115 older patients (age ≥ 66 years) treated on a clinical trial with a 10-day decitabine schedule. None of the patient-related variables showed a significant association with OS. Multivariable analysis revealed that age > 76 years was significantly associated with reduced OS (HR 1.58; p = 0.043) and female sex was associated with superior OS (HR 0.62; p = 0.06). We further compared the genetic profiles of these subgroups. This revealed comparable mutational profiles in patients younger and older than 76 years, but, interestingly, revealed significantly more prevalent mutated ASXL1, STAG2, and U2AF1 in male compared to female patients. In this cohort of older patients treated with decitabine age and sex, but not comorbidities, physical functioning or cytogenetic risk were associated with overall survival.

Details

Title
Age and sex associate with outcome in older AML and high risk MDS patients treated with 10-day decitabine
Author
Hilberink, Jacobien R. 1   VIAFID ORCID Logo  ; van Zeventer, Isabelle A. 1 ; Chitu, Dana A. 2 ; Pabst, Thomas 3   VIAFID ORCID Logo  ; Klein, Saskia K. 4   VIAFID ORCID Logo  ; Stussi, Georg 5   VIAFID ORCID Logo  ; Griskevicius, Laimonas 6 ; Valk, Peter J. M. 7   VIAFID ORCID Logo  ; Cloos, Jacqueline 8 ; van de Loosdrecht, Arjan A. 8 ; Breems, Dimitri 9 ; van Lammeren-Venema, Danielle 10 ; Boersma, Rinske 11 ; Jongen-Lavrencic, Mojca 7 ; Fehr, Martin 12 ; Hoogendoorn, Mels 13 ; Manz, Markus G. 14   VIAFID ORCID Logo  ; Söhne, Maaike 15 ; van Marwijk Kooy, Rien 16 ; Deeren, Dries 17 ; van der Poel, Marjolein W. M. 18 ; Legdeur, Marie Cecile 19 ; Tick, Lidwine 20 ; Chalandon, Yves 21 ; Ammatuna, Emanuele 1 ; Blum, Sabine 22   VIAFID ORCID Logo  ; Löwenberg, Bob 7   VIAFID ORCID Logo  ; Ossenkoppele, Gert J. 8 ; Chitu, D. A. 1 ; Klein, S. K. 4 ; Griskevicius, L. 6 ; Valk, P. J. M. 7 ; Cloos, J. 8 ; van de Loosdrecht, A. A. 8 ; Breems, D. 9 ; van Lammeren-Venema, D. 10 ; Boersma, R. 11 ; Jongen-Lavrencic, M. 7 ; Söhne, M. 15 ; van Marwijk Kooy, R. 16 ; Deeren, D. 17 ; van der Poel, M. W. M. 18 ; Legdeur, M. C. 19 ; Tick, L. 20 ; Ammatuna, E. 1 ; Löwenberg, B. 7 ; Ossenkoppele, G. J. 8 ; Huls, G. 1 ; Pabst, T. 3 ; Stussi, G. 5 ; Fehr, M. 12 ; Manz, M. G. 14 ; Chalandon, Y. 21 ; Blum, S. 22 ; Huls, Gerwin 1 

1  University Medical Center Groningen, Department of Hematology, Groningen, the Netherlands (GRID:grid.4494.d) (ISNI:0000 0000 9558 4598) 
2  Erasmus MC Cancer Institute, Department of Hematology, HOVON Data Center, Rotterdam, the Netherlands (GRID:grid.508717.c) (ISNI:0000 0004 0637 3764) 
3  University Hospital, Inselspital, and University of Bern, Department of Oncology, Bern, Switzerland (GRID:grid.411656.1) (ISNI:0000 0004 0479 0855) 
4  University Medical Center Groningen, Department of Hematology, Groningen, the Netherlands (GRID:grid.4494.d) (ISNI:0000 0000 9558 4598); Meander Hospital Amersfoort, Department of Internal Medicine, Amersfoort, the Netherlands (GRID:grid.4494.d) 
5  Oncology Institute of Southern Switzerland, Ospedale Regionale, Department of Hematology, Bellinzona, Switzerland (GRID:grid.419922.5) 
6  Vilnius University, Hematology, Oncology and Transfusion Medicine Center, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania (GRID:grid.6441.7) (ISNI:0000 0001 2243 2806) 
7  Erasmus University Medical Center and Erasmus MC Cancer Institute, Department of Hematology, Rotterdam, the Netherlands (GRID:grid.5645.2) (ISNI:000000040459992X) 
8  Amsterdam UMC, VU University Medical Center, Cancer Center Amsterdam, Department of Hematology, Amsterdam, the Netherlands (GRID:grid.16872.3a) (ISNI:0000 0004 0435 165X) 
9  ZNA Stuivenberg/Middelheim, Department of Hematology, Antwerp, Belgium (GRID:grid.416667.4) (ISNI:0000 0004 0608 3935) 
10  Hagaziekenhuis, Department of Hematology, Den Haag, the Netherlands (GRID:grid.413591.b) (ISNI:0000 0004 0568 6689) 
11  Amphia Hospital, Department of Hematology, Breda, the Netherlands (GRID:grid.413711.1) (ISNI:0000 0004 4687 1426) 
12  Kantonsspital St. Gallen, Department of Medical oncology and Hematology, St. Gallen, Switzerland (GRID:grid.413349.8) (ISNI:0000 0001 2294 4705) 
13  Medical Center Leeuwarden, Department of Hematology, Leeuwarden, the Netherlands (GRID:grid.414846.b) (ISNI:0000 0004 0419 3743) 
14  Universitätsspital Zurich, Department of Medical Oncology and Hematology, Zurich, Switzerland (GRID:grid.412004.3) (ISNI:0000 0004 0478 9977) 
15  Antonius Hospital, Department of Hematology, Nieuwegein, the Netherlands (GRID:grid.415960.f) (ISNI:0000 0004 0622 1269) 
16  Isala Hospital, Department of Hematology, Zwolle, the Netherlands (GRID:grid.452600.5) (ISNI:0000 0001 0547 5927) 
17  AZ Delta Roeselare, Department of Hematology, Roeselare, Belgium (GRID:grid.478056.8) (ISNI:0000 0004 0439 8570) 
18  Maastricht University Medical Center, Department of Internal Medicine, Division of Hematology, GROW School for Oncology and Developmental Biology, Maastricht, the Netherlands (GRID:grid.412966.e) (ISNI:0000 0004 0480 1382) 
19  Medical Spectrum Twente, Department of Hematology, Enschede, the Netherlands (GRID:grid.415214.7) (ISNI:0000 0004 0399 8347) 
20  Maxima Medical Center, Department of hematology, Veldhoven, the Netherlands (GRID:grid.414711.6) (ISNI:0000 0004 0477 4812) 
21  University Hospital Genève and Faculty of Medicine, University of Genève, Division of hematology, Genève, Switzerland (GRID:grid.8591.5) (ISNI:0000 0001 2322 4988) 
22  Lausanne University Hospital (CHUV), Service and Central Laboratory of Hematology, Department of Oncology and Department of Laboratory Medicine and Pathology, Lausanne, Switzerland (GRID:grid.8515.9) (ISNI:0000 0001 0423 4662) 
Pages
93
Publication year
2023
Publication date
Dec 2023
Publisher
Springer Nature B.V.
e-ISSN
20445385
Source type
Scholarly Journal
Language of publication
English
DOI
https://doi.org/10.1038/s41408-023-00850-6
ProQuest document ID
2827370270
Copyright
© The Author(s) 2023. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.