Inpatient Geriatric Assessment Detects Impairment Among Older Adults Receiving Induction Chemotherapy for Acute Myelogenous Leukemia.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 1401-1401
Author(s):  
Heidi D Klepin ◽  
Ann M Geiger ◽  
Jeff Williamson ◽  
Stephen Kritchevsky ◽  
Janet A Tooze ◽  
...  
Keyword(s):  
Older Adults ◽  
Activities Of Daily Living ◽  
Grip Strength ◽  
Induction Chemotherapy ◽  
Geriatric Assessment ◽  
Acute Myelogenous Leukemia ◽  
Daily Living ◽  
Myelogenous Leukemia ◽  
Performance Score ◽  
Acute Myelogenous

Abstract Abstract 1401 Poster Board I-423 Background: Acute myelogenous leukemia (AML) is a disease which largely affects older adults, for whom optimal therapy is unclear. Evidence-based strategies to identify those older adults who may tolerate and benefit from standard therapies are lacking. Objective: Test the utility of a bedside geriatric assessment (GA) to detect impairment in multiple geriatric domains among older adults initiating induction chemotherapy for AML. Methods: Ongoing prospective study of patients ≥60 years of age with newly diagnosed AML and planned induction chemotherapy admitted to Wake Forest University. Bedside geriatric assessment (GA) was performed during inpatient work-up for AML. GA measures included the Modified Mini-Mental Status Exam (3MS), Center for Epidemiologic Studies Depression Scale (CES-D), Distress thermometer, Hematopoietic Cell Transplantation Comorbidity Index (HCT-CI), Pepper Assessment Tool for Disability ([PAT-D], includes self- reported activities of daily living (ADL), instrumental activities of daily living (IADL), and mobility questions), Short Physical Performance Battery ([SPPB], includes timed 4-meter walk, chair stands, standing balance), and grip strength. Results: 26 of 29 eligible patients enrolled between 1/2009 and 8/2009. The median age was 68 (range 60-82) years, and 42.3% were female. Prior myelodysplastic syndrome was present in 34.6%, with intermediate or poor-risk cytogenetics in 95.6%. Baseline laboratory measures included white blood cell count (mean 17.3×103/mm3, SD 25.0×103), hemoglobin (mean 9.2g/dl, SD 1.5), lactate dehydrogenase (mean 282.4 U/L, SD 168.8). Mean baseline GA scores included: 3MS 83.0 (SD 14.7), CES-D 9.4 (SD 9.3), Distress 3.8 (SD 3.4), HCT-CI 1.3 (SD 1.6), PAT-D 1.4 (SD 0.7), SPPB 7.1 (SD 3.9), grip strength 32.4 kilograms (SD 9.2). Although 84.6% of subjects had an Eastern Cooperative Oncology Group (ECOG) Performance score <2, a substantial proportion met criteria for impairment in multiple geriatric domains. Conclusions: GA measures detect abnormalities which are not adequately reflected by the ECOG performance score in older adults with AML. Future analyses from this ongoing study will evaluate whether these abnormalities are independently associated with treatment-related morbidity and survival. Disclosures: No relevant conflicts of interest to declare.

Geriatric Assessment Predicts Overall Survival Among Older Adults Receiving Induction Chemotherapy for Acute Myelogenous Leukemia.

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 1535-1535 ◽  
Author(s):  
Heidi D. Klepin ◽  
Janet A. Tooze ◽  
Ann M. Geiger ◽  
Stephen Kritchevsky ◽  
Jeff Williamson ◽  
...  
Keyword(s):  
Older Adults ◽  
Overall Survival ◽  
Activities Of Daily Living ◽  
Grip Strength ◽  
Geriatric Assessment ◽  
Induction Therapy ◽  
Acute Myelogenous Leukemia ◽  
Daily Living ◽  
Myelogenous Leukemia ◽  
Acute Myelogenous

Abstract Abstract 1535 Background: Acute myelogenous leukemia (AML) is a disease which largely affects older adults, for whom optimal therapy is unclear. Evidence-based strategies to identify those older adults who may tolerate and benefit from standard therapies are lacking. Objective: Evaluate the predictive value of bedside geriatric assessment (GA) on overall survival (OS) for older adults receiving induction therapy for AML. Methods: Ongoing prospective study of patients ≥60 years of age with newly diagnosed AML and planned induction chemotherapy admitted to Wake Forest University. Bedside GA was performed during inpatient work-up for AML. GA measures included the Modified Mini-Mental Status Exam (3MS), Center for Epidemiologic Studies Depression Scale (CES-D), Distress thermometer, Pepper Assessment Tool for Disability ([PAT-D], includes self- reported activities of daily living (ADL), instrumental activities of daily living (IADL), and mobility questions), Short Physical Performance Battery ([SPPB], includes timed 4-meter walk, chair stands, standing balance), and grip strength. Cox proportional hazards models were fit for each GA measure as a predictor of OS, controlling for age, gender, Eastern Cooperative Oncology Group (ECOG) score, Hematopoietic Cell Transplantation Comorbidity Index (HCT-CI) score, and cytogenetic risk group. The median follow-up was 4.7 months. Results: Among 53 consecutive patients the mean age was 69 (SD 11.5) years, 59.3% were female, and 46.3% had significant comorbidity (HCT-CI score >1). The majority had intermediate (72.6%) or poor risk (23.6%) cytogenetics. Approximately two thirds (64.7%) received standard induction therapy with anthracycline, cytarabine ± etoposide. Mean baseline GA scores included: 3MS 82.4 (SD 9.6), CES-D 13.5 (SD 11.3), Distress 4.2 (SD 3.3), PAT-D 1.6 (SD 0.6), SPPB 6.4 (SD 4.2), grip strength 32.0 kilograms (SD 8.5). In adjusted analyses, better performance on the cognitive screen (3MS) was associated with improved OS (HR 0.94, 95% CI 0.89–0.99). There was a trend towards worse OS among individuals who screened positive for depression at baseline (CES-D>16) (HR 2.3, 95% CI 0.75–6.80) and among those with a slower gait speed (< 1 meter/second) (HR 5.9, 95% CI 0.80–45.3). Additional baseline GA measures were not associated with OS in this analysis. Conclusions: Geriatric assessment measures may independently predict OS among older adults receiving induction therapy for AML. If validated in future studies, these screening measures may improve risk stratification and inform interventions to improve outcomes for older adults with AML. Supported by the American Society of Hematology Scholar Award, Atlantic Philanthropies, the John A. Hartford Foundation, ASP, and the WFU Pepper Center (P30 AG-021332). Disclosures: No relevant conflicts of interest to declare.

scholarly journals Geriatric assessment predicts survival for older adults receiving induction chemotherapy for acute myelogenous leukemia

Blood ◽  
2013 ◽  
Vol 121 (21) ◽  
pp. 4287-4294 ◽  
Author(s):  
Heidi D. Klepin ◽  
Ann M. Geiger ◽  
Janet A. Tooze ◽  
Stephen B. Kritchevsky ◽  
Jeff D. Williamson ◽  
...  
Keyword(s):  
Older Adults ◽  
Physical Function ◽  
Induction Chemotherapy ◽  
Geriatric Assessment ◽  
Acute Myelogenous Leukemia ◽  
Trial Design ◽  
Myelogenous Leukemia ◽  
Key Points ◽  
Prediction Of Survival ◽  
Acute Myelogenous

Key Points Geriatric assessment, with a focus on cognitive and physical function, improves prediction of survival among older adults treated for AML. Use of geriatric assessment may inform trial design and interventions to improve outcomes for older adults with AML.

scholarly journals The Feasibility of Inpatient Geriatric Assessment for Older Adults Receiving Induction Chemotherapy for Acute Myelogenous Leukemia

2011 ◽  
Vol 59 (10) ◽  
pp. 1837-1846 ◽  
Author(s):  
Heidi D. Klepin ◽  
Ann M. Geiger ◽  
Janet A. Tooze ◽  
Stephen B. Kritchevsky ◽  
Jeff D. Williamson ◽  
...  
Keyword(s):  
Older Adults ◽  
Induction Chemotherapy ◽  
Geriatric Assessment ◽  
Acute Myelogenous Leukemia ◽  
Myelogenous Leukemia ◽  
Acute Myelogenous

Feasibility of Inpatient Geriatric Assessment for Older Adults with Newly Diagnosed Acute Myelogenous Leukemia

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 3996-3996
Author(s):  
Heidi D Klepin ◽  
Leslie Renee Ellis ◽  
Denise Levitan ◽  
Bayard Powell
Keyword(s):  
Older Adults ◽  
Grip Strength ◽  
Physical Performance ◽  
Geriatric Assessment ◽  
Acute Myelogenous Leukemia ◽  
Self Report ◽  
Myelogenous Leukemia ◽  
Newly Diagnosed ◽  
Wide Range ◽  
Acute Myelogenous

Abstract Background: Acute myelogenous leukemia (AML) is a disease which largely affects older adults, for whom optimal therapy is unclear. Evidence based strategies are lacking to identify those older adults who may tolerate and benefit from standard therapies. Objective: Test the feasibility of pre-treatment, inpatient geriatric assessment (GA) in older adults hospitalized with newly diagnosed AML. Methods: Prospective evaluation of consecutive patients ≥60 years of age with newly diagnosed AML and planned induction chemotherapy admitted to a single institution from 6/2007–6/2008. Bedside GA was performed within 72 hours of diagnosis. In addition to demographics and routine labs, the GA measures obtained by a trained nurse included Mini-Mental Status Exam (MMSE), Center for Epidemiologic Studies Depression Scale (CES-D), Charlson Comorbidity Index (CCI), Vulnerable Elders Survey-13 (VES-13), Short Physical Performance Battery (SPPB, includes timed 4 meter walk, chair stands, standing balance), and grip strength. Measures to assess feasibility included: recruitment; time to complete the assessment, and proportion completing entire GA battery. Results: Among 22 eligible inpatients, 11 enrolled (50%). The median age was 71 (range 63–78) and 72.7% were female. Poor risk cytogenetics were present in 27.3%. Laboratory measures included white blood cell count (mean=24.6×103/mm3, SD 26.2×103), hemoglobin (mean=8.5 g/dl, SD 1.6), platelet count (mean=60.3×103/mm3, SD=38.4×103), lactate dehydrogenase (LDH) (mean=340.0 U/L, SD=235.1), and albumin (mean=3.2 g/dl, SD=0.36). 66.6% of participants completed the entire GA battery; the remainder completed only self-report measures. Mean time for completion of the GA was 36.8 minutes (SD 9.8). Mean scores for survey measures included: MMSE=26.1 (range 21–30, SD 3.2), CCI=1.6 (range 0–4, SD 1.1), CES-D=22.9 (range 8–37, SD 11.0), VES-13 survey=5.0 (range 1–8, SD 2.5). A wide range of objective physical performance was demonstrated including mean SPPB total score=7.4 (range 5–10; SD 2.1), mean timed 4 meter walk=12.9 seconds (range 6.6–22.1; SD 5.1), and mean grip strength=29.3 (range 12–62; SD 16.8). Conclusions: Inpatient GA including physical performance assessment is feasible in older adults hospitalized for AML and our preliminary findings demonstrate significant variability in cognitive, emotional and physical status. These measures may represent valuable candidate predictors of outcomes, and ongoing studies will identify which measures are most predictive of treatment morbidity and response.

Stem Cell Transplant Versus Chemotherapy in Older Adults with Acute Myelogenous Leukemia In First Remission

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 2146-2146
Author(s):  
Ellin Berman ◽  
Molly Maloy ◽  
Sean M. Devlin ◽  
Esperanza B Papadopoulos ◽  
Ann A. Jakubowski
Keyword(s):  
Older Adults ◽  
Overall Survival ◽  
Stem Cell ◽  
Cord Blood ◽  
Induction Chemotherapy ◽  
Acute Myelogenous Leukemia ◽  
Stem Cell Transplant ◽  
Myelogenous Leukemia ◽  
Cell Transplant ◽  
Acute Myelogenous

Abstract Introduction Optimal therapy for older adults with acute myelogenous leukemia (AML) who achieve remission following induction chemotherapy has not been determined. Options include consolidation chemotherapy (CC) or stem cell transplant (SCT) if an appropriate donor is identified. In order to determine whether SCT improved overall survival (OS) or whether associated toxicity was increased, we performed a retrospective study comparing SCT with CC in this older age group. Methods All adult patients ages 60 to 75 years with AML in 1st remission (CR1) who underwent a SCT at MSKCC between 2001 and 2013 were reviewed and compared to age-matched patients with AML who achieved CR1 and received CC. A landmark analysis at 3 months following CR1 was used to compare OS for the 2 patient groups. Only SCT patients transplanted by landmark time were included in the analysis. Overall survival was compared using Kaplan-Meier methodology. Results Sixty-eight patients were identified for the SCT group. Thirty-two patients were identified for the CC group (Table). Stem cell sources included: peripheral blood (n=63), cord blood (n=4) and bone marrow (n=1). Fifty-six patients received a T cell depleted transplant (32 with ClinMACsTM and 24 with IsolexTM ) and 12 received an unmodified product. Conditioning regimens were busulfan/melphalan/ fludarabine (n=54), melphalan/fludarabine (n=4), cyclophosphamide/fludarabine/thiotepa/ TBI (n=4), fludarabine/busulfan (n=3), busulfan/melphalan (n=2) and thiotepa/fludarabine/TBI (n=1). Donors included matched unrelated (n=28), matched related (n=25), mismatched unrelated (n=11) and mismatched cord blood (n=4). For patients in the CC group, induction chemotherapy included cytarabine in combination with either idarubicin (n=21), daunorubicin (n=10), or mitoxantrone plus etoposide (n=1). Forty-four patients received their transplant by the 3 month landmark and 30 patients in the CC group were alive at the landmark and were included in the OS analysis. Deaths in the SCT group included 4 patients from infection, 1 from treatment-related toxicity, and 1 from relapsed disease. The estimated OS at 2 years in the landmark groups were 64% in the SCT group and 42% in the CC group (p=0.04). Conclusions Recognizing the inherent bias when retrospective studies compare SCT and CC, these data support the use of SCT for older patients with AML in CR1 who have an appropriate donor. Despite the older age, there was a statistically significant better OS with low 100 day mortality for those patients who underwent SCT. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Chemotherapy for acute myelogenous leukemia in children and adults: VAPA update

Blood ◽  
1983 ◽  
Vol 62 (2) ◽  
pp. 315-319 ◽  
Author(s):  
HJ Weinstein ◽  
RJ Mayer ◽  
DS Rosenthal ◽  
FS Coral ◽  
BM Camitta ◽  
...  
Keyword(s):  
Complete Remission ◽  
Maintenance Therapy ◽  
Induction Chemotherapy ◽  
Acute Myelogenous Leukemia ◽  
Myelogenous Leukemia ◽  
Kaplan Meier ◽  
High Incidence ◽  
Acute Myelogenous ◽  
Leukemia In Children

Abstract We designed a protocol (VAPA) that featured 14 mo of intensive postremission induction chemotherapy in an effort to improve remission durations for patients with acute myelogenous leukemia (AML). One hundred and seven patients under 50 yr of age were entered into this study. The rate of complete remission is 70%. A Kaplan-Meier analysis of patients entering remission predicts that 56% +/- 7% (+/-SE) of patients less than 18 yr and 45% +/- 9% of patients aged 18–50 yr will remain in remission at 3 yr (median follow-up is 43 mo). Patients with the monocytic subtype had a statistically significant shorter duration of remission (2-sided p less than 0.05). There was a high incidence of primary CNS relapse in children. Thirty-one of 41 patients who completed the regimen remain in remission without maintenance therapy. We conclude that the VAPA protocol continues to offer a promising approach to treatment of AML.

scholarly journals Associations Between Fine Motor Performance in Activities of Daily Living and Cognitive Ability in a Nondemented Sample of Older Adults: Implications for Geriatric Physical Rehabilitation

2016 ◽  
Vol 29 (7) ◽  
pp. 1144-1159 ◽  
Author(s):  
Elizabeth B. Fauth ◽  
Sydney Y. Schaefer ◽  
Steven H. Zarit ◽  
Marie Ernsth-Bravell ◽  
Boo Johansson
Keyword(s):  
Older Adults ◽  
Depressive Symptoms ◽  
Activities Of Daily Living ◽  
Cognitive Ability ◽  
Grip Strength ◽  
Daily Living ◽  
Ordinary Least Squares ◽  
Physical Rehabilitation ◽  
Fine Motor ◽  
Physical Ability

Objective: Fine motor ability (FMA) is essential in certain activities of daily living (ADL) and is considered mostly as a component of physical function. We hypothesize that cognitive ability explains significant variance in ADL-related FMA, above and beyond what is explained by physical ability (grip strength). Method: Origins of Variance in the Old Old Study (OCTO)-Twin participants ( n = 218), aged 80+ (dementia, stroke, Parkinson’s disease excluded) were assessed on depressive symptoms (Center for Epidemiologic Studies–Depression Scale [CES-D]), a cognitive battery, grip strength, and FMA. Results: In a series of ordinary least squares regression models, FMA was not associated with gender or depressive symptoms, but was associated with age (marginally; β = −.164, p = .051), grip strength (β = −.381, p < .01), and one cognitive measure, perceptual speed (β = −.249, p < .01). Discussion: In nondemented older adults, cognitive speed predicts ADL-related FMA after controlling for age and physical ability. Physical rehabilitation of FMA in ADL tasks should consider the importance of cognitive ability, even in nondemented older adults.

scholarly journals 1090. Practicing Antimicrobial Stewardship: De-escalating Empiric Antibiotics in Patients with Acute Myelogenous Leukemia and Neutropenic Fever

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S387-S388
Author(s):  
Risa Fuller ◽  
Erin Moshier ◽  
Samantha E Jacobs ◽  
Douglas Tremblay ◽  
Guido Lancman ◽  
...  
Keyword(s):  
Induction Chemotherapy ◽  
Acute Myelogenous Leukemia ◽  
Neutropenic Fever ◽  
Myelogenous Leukemia ◽  
Recurrent Fever ◽  
Antibacterial Prophylaxis ◽  
Single Temperature ◽  
Acute Myelogenous ◽  
Icu Transfer ◽  
Infectious Source

Abstract Background In the era of increased antibiotic resistance, minimizing the use of broad-spectrum antibiotics is essential. We sought to determine whether there was a difference in risk of recurrent fever in patients with acute myelogenous leukemia (AML) and neutropenic fever without an identifiable source in which antibacterials were de-escalated prior to neutrophil recovery compared with those that continued until recovery. Methods We performed a retrospective chart review of adult patients with AML undergoing induction chemotherapy at Mount Sinai Hospital in New York, NY from 2009–2017. Neutropenic fever was defined as a temperature of 100.4°F for 1 hour or single temperature of 101°F in a patient with an absolute neutrophil count (ANC) of less than 500 cells/μL. Febrile patients were treated with cefepime, piperacillin–tazobactam, or a carbapenem. De-escalation was defined as changing from one of these antibiotics to antibacterial prophylaxis such as levofloxacin, or discontinuing antibiotics. The primary outcome was recurrent neutropenic fever. Secondary outcomes were adverse events related to antibiotics, intensive care unit (ICU) transfer, and all-cause mortality. Results Of 390 AML patients undergoing induction chemotherapy, 135 had a neutropenic fever; of whom, 77 had no identifiable infectious source. Of those 77, 38 had antibiotics de-escalated prior to ANC recovery (“short”) and 39 had antibiotics continued until ANC recovery or discharge (“long”). Demographics were similar (Table 1). The median number of antibiotic days for the first fever was 9 in the short group and 15 in the long group (P = 0.0008) (Table 2). Risk of recurrent fever was 46% lower in the short group compared with the long group (hazard ratio 0.54, 95% CI: 0.34–0.88; P = 0.01). There was no significant difference in ICU transfer (P = 0.11) and in-hospital mortality (P = 0.36) between the short and long groups (Table 2). There were 7 adverse drug outcomes, 2 in the short group and 5 in the long group (Table 3). Conclusion Antibiotic de-escalation in AML patients with neutropenic fever with no identifiable infectious source was associated with a lower rate of recurrent fever without affecting ICU transfer, adverse drug events, and death. Physicians should consider de-escalation prior to ANC recovery in the appropriate setting. Disclosures All authors: No reported disclosures.

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