Poster Presentation Australian and New Zealand Society for Geriatric Medicine Annual Scientific Meeting 2025

Frailty and chemotherapy intensity in newly diagnosed older patients with acute myeloid leukaemia (AML) (118989)

Navin T Mathew 1 , Samantha Bahn 2 , Ian McPherson 3 , Camilla Simonsen 2 , Nicholas McVilly 2 , Aaron Din How Sia 1 , Leila Shafiee Hanjani 4 , Natasha Reid 4 , Courtney Tate 2 5 , Robyn Berry 3 , Elizabeth Costin 2 , Paula Marlton 2 5 , Ruth Hubbard 1 5 , Peter Mollee 2 5 , Victoria Y Ling 2 5
  1. Department of Geriatrics , Princess Alexandra Hospital , Brisbane, Queensland , Australia
  2. Department of Haematology , Princess Alexandra Hospital , Brisbane, Queensland , Australia
  3. Cancer Care Services , Princess Alexandra Hospital , Brisbane, Queensland, Australia
  4. Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
  5. Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia

Aims: AML is an aggressive cancer of older adults. In this group, we aimed to determine how frailty impacts treatment intensity choice, deliverability and survival.

Methods: We retrospectively analysed AML patients ≥60 years from the hospital database between January 2019 and December 2023. Rockwood Clinical Frailty Score (CFS) was assessed at presentation or retrospectively by chart reviews. Therapy intensity was classified as Intensive Chemotherapy (IC), Lower Intensity (LI) e.g. Venetoclax / azacitidine and Single Agent therapies (SA) e.g. hypomethylating agents. Number of delivered cycles, Relative dose intensity (RDI: delivered dose as a percentage of intended dose) and overall survival (OS) were measured.

Results: Of 128 patients, 96 (75%) received active therapies (59% IC, 33% LI, 8% SA). Median CFS was 3 with 43 (45%) being fit (CFS 1-2), 45 (47%) pre-frail (CFS 3-4) and 8 (8%) frail (CFS ≥5). Fifty-five (99%) of IC-treated patients were fit (n=34) or pre-frail (n=21), with no differences in median delivered cycles or RDI between fit and pre-frail. In LI-treated patients, 7 (22%), 20 (62%) and 5 (16%) patients were fit, pre-frail and frail. Cycles delivered reduced with increasing frailty (median 5 vs 3 vs 1 cycle/s) from fit to frail. Per cycle RDI also reduced with increasing frailty (79% vs 71% vs 60%). Median OS was similar between IC and LI patients. Within LI group, lower OS was seen in frail vs non-frail (2 vs 9 months).

Conclusions: Increased frailty precludes intensive chemotherapy. Frailty is associated with reduced therapy deliverability and shorter overall survival.