Systematic Review of Frailty Assessment Tools for Elderly Patients with Acute Myeloid Leukemia

Context Treating elderly AML patients (\u003e65 years) with intensive remission-induction chemotherapy without proper frailty assessment results in poor survival. We hypothesize a lack of health status measurement tools specific for elderly AML patients that inform risk stratification and treatment decisions. Objective To determine the availability of frailty assessment tools for elderly AML patients. Methods We searched MEDLINE, EMBASE, PsycINFO and Cochrane CENTRAL databases from inception through March 5, 2020, for case-control, cohort, randomized controlled and validation studies. We used MeSH and free text terms for acute myeloid leukemia, frailty and the elderly. We included all languages and conference abstracts covered in the databases. Two reviewers independently screened references against inclusion/exclusion criteria and resolved differences through discussion. Results Out of 4115 retrieved references, 29 studies (3,526 patients) met eligibility criteria. We did not find any frailty assessment tools specific for elderly AML patients. Our search revealed 2 main categories of functional status measurement tools used in elderly AML patients. The first is disease-specific and used for functional status evaluation of cancer patients of any age. They included the Karnofsky performance scale (5 studies, 1,136 patients) and the Eastern Cooperative Oncology Group (ECOG) performance scale (6 studies, 458 patients). The second is age-specific and used for functional status assessment of elderly patients. These were Comprehensive Geriatric Assessment (CGA) tools (8 studies, 870 patients) including the Clinical Frailty Scale, instrumental activities of daily living functional score, Grip strength, and Timed Up and Go Test (TUGT). Both Karnofsky, ECOG performance scales, and most of the CGA tools were not significantly predictive of poor overall survival, except for a TUGT of more than 10 seconds [n = 96, HR 3.4 (95% CI 1.4 – 8.0), P = 0.005] and an abnormal CRP level [n = 96, HR 4.30 (95% CI 1.60 - 11.50), P = 0.003]. Conclusions Our systematic review demonstrates a lack of specific frailty assessment tools for elderly AML patients. There is a need to develop a novel, practical, time and cost-efficient health status measurement tool that will assess frailty in elderly AML patients to support hematologists in risk stratification and decision making.