Standard scales, such as ECOG Performance Status, Hematopoietic Cell Transplantation Comorbidity Index (HCT-CI), and Activities of Daily Living (ADL), are commonly used to stratify patients with acute myeloid leukemia (AML) for intensive chemotherapy (IC). Comprehensive geriatric assessment (CGA) may further identify patients at risk of treatment-related toxicity, but it is underutilized due to time constraints. We aimed to evaluate the predictive relevance of CGA domains in elderly AML patients selected for IC using ECOG, HCT-CI, and ADL. In this prospective study, patients aged 60–75 were eligible for IC if they had ECOG < 2, HCT-CI < 3, and ADL = 6. Regimens included daunorubicin and cytarabine (DA) with or without cladribine (DAC). Additional CGA domains assessed were: Instrumental Activities of Daily Living (IADL), Timed Up-and-Go Test (TUG), Geriatric Depression Scale (GDS), Mini-Mental State Examination (MMSE), and Mini Nutritional Assessment (MNA), screening tests Geriatric 8 (G8) and Vulnerable Elders Survey-13 (VES-13). Eighty-five patients (median age: 65) were analyzed. HCT-CI scores of 0–1 were seen in 72%; 23.5% had secondary AML. Intermediate and adverse cytogenetic risk was present in 33% and 38%, respectively. Complete remission with or without incomplete hematologic recovery (CR/CRi) was achieved in 65%. Median overall survival (OS) and relapse-free survival (RFS) were 16.0 and 15.3 months, respectively. No significant differences in CR, OS, or RFS existed between DA and DAC regimens. None of the tested CGA domains significantly affected CR/CRi, OS, or RFS. In conclusion, CGA domains did not provide additional predictive value in AML patients selected for IC based on ECOG < 2, HCT-CI < 3, and ADL = 6.
Supplementary Information: The online version contains supplementary material available at 10.1007/s00277-026-06837-0.
Keywords: Acute myeloid leukemia; Geriatric assessment; Intensive chemotherapy; Treatment fitness.