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Comment & Response
July 2018

Incorporating Physical Function and Cognition Into Mortality Risk Assessment for Acute Myeloid Leukemia—Reply

Author Affiliations
  • 1Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
  • 2Division of Medical Oncology, Department of Medicine, University of Washington School of Medicine, Seattle
  • 3Clinical Statistics Program, Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
  • 4Department of Biostatistics, University of Washington School of Public Health, Seattle
JAMA Oncol. 2018;4(7):1014-1015. doi:10.1001/jamaoncol.2018.0677

In Reply We read with interest the call by Drs Loh and Klepin for expanding health assessment tools for older patients with newly diagnosed acute myeloid leukemia (AML).

We would like to point out that we developed and validated the AML–composite model (AML-CM) in all adults with AML because we believe that physiologic rather than calendar age should be used for purposes of treatment decision making. It is a commonplace observation that adults younger than 60 years with significant comorbidity burden are “physiologically older” than older individuals who have fewer comorbidities. For example, in our study,1 there were 16 patients with a median age of 52.5 (range, 22-59) years whose AML-CM scores of 12 to 15 mainly reflected a relatively high augmented Hematopoietic Cell Transplantation–Comorbidity Index (HCT-CI) score (median score, 11; range, 8-13). Six of these 16 (38%) died. In contrast, there were 15 patients who, despite a median age of 71 (range, 66-82) years, all had augmented HCT-CI scores of 0 and corresponding AML-CM median scores of 3 (range, 2-4) that solely reflected their older age and “adverse” cytogenetic abnormalities. Three of these 15 patients died (20%). We cannot overemphasize the importance of not merely looking at age—for example, younger vs older than 60 years—when deciding on therapy for AML or considering comprehensive health profile assessment. Nonetheless, clinical trials are commonly divided into those for people younger vs older than 60 years, a practice that we hope to change by the use of the AML-CM.

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