Prognostic and Serial Assessment of Functional/Psychosocial Factors in Older Adults Receiving AML Induction Chemotherapy

Older adults with acute myeloid leukemia (AML) have a poor prognosis and high heterogeneity in terms of fitness and disease-related parameters, yet standardized assessment integrating patient-related factors is limited. We investigated the prognostic value of baseline health-related quality of life (HRQoL) and performance parameters in older adults undergoing induction chemotherapy (IC). In this multicenter, prospective study 82 patients ≥60 years with newly diagnosed AML were assessed over one year. Assessment included HRQoL, performance status, psychological distress, resilience, comorbidities, and functional independence. Primary endpoint was overall survival (OS), secondary endpoints HRQoL and psychological distress. Median age was 68 years. 62% proceeded to allogeneic transplantation. Median OS was 22.1 months. In multivariate analysis, none of the patient-related factors were significantly associated with OS; role functioning showed a non-significant tendency (p=0.083). High-risk cytogenetics (p=0.0198), elevated creatinine (p=0.027), and tAML (p=0.015) were significantly associated with reduced OS. Most HRQoL domains worsened initially but improved by 12 months, whereas cognitive function and resilience remained impaired. In summary, disease-related variables, rather than functional or psychosocial parameters, predicted OS. No significant influence of depression or anxiety on OS was observed. Persistent deficits in cognition and resilience highlight important targets for supportive interventions. German Clinical trial ID: DRKS00003601