Dynamic changes in physical function during intensive chemotherapy affect transplant outcomes in older adults with AML

Gi-June Min; Byung-Sik Cho; Daehun Kwag; Sung-Soo Park; Silvia Park; Jae-Ho Yoon; Sung-Eun Lee; Ki-Seong Eom; Yoo-Jin Kim; Seok Lee; Chang-Ki Min; Seok-Goo Cho; Jong Wook Lee; Hee-Je Kim

doi:10.3389/fonc.2023.1281782

Dynamic changes in physical function during intensive chemotherapy affect transplant outcomes in older adults with AML

Front Oncol. 2023 Nov 7:13:1281782. doi: 10.3389/fonc.2023.1281782. eCollection 2023.

Authors

Gi-June Min^{1

2}, Byung-Sik Cho^{1

2}, Daehun Kwag^{1

2}, Sung-Soo Park^{1

2}, Silvia Park^{1

2}, Jae-Ho Yoon^{1

2}, Sung-Eun Lee^{1

2}, Ki-Seong Eom^{1

2}, Yoo-Jin Kim^{1

2}, Seok Lee^{1

2}, Chang-Ki Min^{1

2}, Seok-Goo Cho¹, Jong Wook Lee¹, Hee-Je Kim^{1

2}

Affiliations

¹ Department of Hematology, Catholic Hematology Hospital, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
² Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.

Abstract

Introduction: Intensive chemotherapy (IC) can affect all geriatric assessment (GA) domains in older adults with acute myeloid leukemia (AML), but data on the effects of these changes on transplant outcomes are lacking.

Methods: Therefore, we prospectively assessed the prognostic role of GA domains at diagnosis and allogeneic hematopoietic stem cell transplantation (allo-HSCT) in 51 patients with AML aged ≥60 years who achieved complete remission after IC. We performed both baseline and pre-allo-HSCT GA; moreover, physical function, including a short physical performance battery (SPPB), cognitive function, psychological function, nutritional status, and social support were examined.

Results: All GA domains showed dynamic changes between the two time points. The directions of change were statistically significant for social support, self-reported physical and psychological functions, and distress, but not for nutritional status, cognitive function, or physical function. Among all GA domains at each time point, only poor physical function and its submaneuvers at diagnosis but not at allo-HSCT were significantly associated with inferior survival. In particular, since the direction of change varied between patients, we found that patients whose physical function improved before allo-HSCT were more likely to survive longer than those with persistently impaired SPPB (55.6% vs. 28.6%, p=0.268). Finally, persistent impairment in SPPB (28.6% vs. 65.9%, p=0.006), tandem stand (0% vs. 63.3%, p=0.012), sit-and-stand (41.2% vs. 70.6%, p=0.009), and gait speed (38.5% vs. 68.4%, p=0.027) further strongly predicted inferior survival.

Discussion: This study showed that IC courses can induce dynamic changes in different directions in the GA domains of each patient and that changes in objectively measured physical function can predict transplant outcomes.

Keywords: acute myeloid leukemia; allogeneic transplantation; geriatric assessment; physical function; survival outcomes.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This research was supported by the National Research Foundation of Korea funded by the Korean government (MSIT; 2022R1A2C2004517) and the Research Fund of Seoul St. Mary’s Hospital associated with The Catholic University of Korea.