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Myeloma). An extended scoring system (range 0-5) was
developed, based on items we identified as predictive factors
in this analysis, ie: autonomy (IADL<5 (men) and IADL<8
(women)), nutritional status (MNA<24), cognition (MMSE
<24), anemia (HB <11g/dl) and inflammation (CRP
2mg/l).
The population was stratified into 3 groups: fit (score=0),
vulnerable (score= 1 or 2) and “frail” (score= 3, 4 or 5). The 6
months OS was 100% in fit, 79% in vulnerable (hazard ratio
(HR), 0.0; P=.961) and 37% in “frail” patients (HR, 0.24; P<.001).
Causes of death remain disease-related in a majority of the
patients (82%). The early death rate was even higher in poor
prognostic diseases such as MDS and/or Acute Leukemias (6
months OS was 20% in the frail group).
Conclusion:
In our selected population of patients
with malignant hemopathies, “clinically fit” to receive
chemotherapy, our “frailty score” predicts early deaths. This
scoring detects unsuspected “frail” patients who may benefit
from adapted chemotherapy or palliative care. Further
prospective analyses in a larger population, are on going to
refine the score according to the diseases.
Reference:
[1] Dubruille S et al. Identification of clinical parameters
predictive of one-year survival using two geriatric tools in
clinically fit older patientswith haematological malignancies:
major impact of cognition. J Geriatr Oncol, 2015, 6, 362-369.
Disclosure of interest:
None declared
Keywords:
Frailty score, malignant hemopathies, mild
cognitive impairment, older
P044
EFFECT OF ADEQUATE HYPOMETHYLATING AGENT (HMA)
THERAPY ON ADVERSE PROGNOSTIC FACTORS IN VERY
ELDERLY PATIENTS (
75 YRS) WITH MYELODYSPLASTIC
SYNDROME (MDS)
V. Lohiya
1,
*, G. Sherwood
1
, U. Borate
1
1
Hematology/Oncology, University of Alabama at Birmingham,
Birmingham, USA
Introduction:
Very elderly MDS patients (
75 years) have
limited therapeutic options and are usually ineligible for
allogeneic stem cell transplantation
Objectives:
We studied the impact of availableMDS therapies
in very elderly MDS patients and their correlation with patient
and disease characteristics as well as patient outcomes
Methods:
We performed a retrospective analysis of MDS
patients (
75 years) from 2008 to 2014, with a minimum follow
up of 12 months. We stratified patients based on therapy
into two groups – HMA group (therapy with
1 cycle of HMA;
Azacitidine or Decitabine or both) and the non-HMA group
(therapywith erythropoietin stimulating agents, lenalidomide,
growth factors, transfusions and other supportive measures).
We analyzed demographics, ECOG performance status (PS),
risk categories (IPSS /IPSS-R scoring system), blast percentage,
and overall survival (OS) in this population. We analyzed
group differences for all the above-mentioned parameters
and the effects of variables of interest on OS.
Results:
The study population included 58 patients of
which 35 patients were males (60%). Median age was 78 years.
Forty patients (71%) of patients had good, 6% had intermediate
and 23% had poor karyotypic profiles by the IPSS scoring
system. ECOG
2 was observed in 44% of the patients with
no significant differences in both groups. Median OS for the
entire study population was noted to be 15.5 months (7-34m).
There were 25 patients in the HMA group and 33 patients
in the non-HMA group. The blast percentage was higher in
HMA group (20.5% vs 9.4%) compared to non-HMA group.
More patients had a good karyotypic profile in the non-HMA
group when compared to HMA group (80% vs 60%). There was
a statistically significant difference between the mean IPSS
and R-IPSS prognostic scores in non-HMA and HMA group
(0.9 vs 1.7, p=0.010 and 3.5 vs 5.5, p=0.002) respectively. There
was no significant difference in median OS between the non-
HMA and HMA group (16.5 m (7-53) vs 15.5 m (5-19) p=0.278)
respectively but the mean survival rates between non-HMA
and HMA group were statistically different (32.81m vs 15.85m,
p=0.034).. In the univariate analysis for the entire sample,
higher IPSS score; R-IPSS score, and higher blast percentage
were associated with increased rate of events. Moreover,
rates of events were found to be lower in patients who did
not receive HMA therapy (HR – 0.45, p=0.033), however in
multivariable analysis, only higher blast percentage was
associated with increased rate of events (HR – 1.06 p=0.025
95% CI – 1.004-1.11). Patients in the HMA group received
average of 7.8 cycles
Conclusion:
Our study found that very elderly patients
who received adequate HMA therapy despite having high-
risk disease had similar median OS compared to patients
who received other therapies even with comparable PS. The
comparable median OS in the high-risk group despite several
adverse prognostic characteristics compared to the non-
HMA group may be attributed to the use of adequate HMA
therapy and its impact on disease progression. In conclusion,
adequate HMA therapy may benefit even very elderly patients
with high-risk disease. Our study did not evaluate the impact
of quality of life, hospitalizations and number of transfusions
in both groups and further studies need to be done to better
characterize this aspect of the disease and its therapy
Disclosure of interest:
None declared
Keywords:
Hypomethylating agents, very elderly patients,
MDS
P045
FALLS IN OLDER CANCER PATIENTS UNDERGOING
SURGERY: PREVALENCE AND ASSOCIATION WITH
GERIATRIC SYNDROMES AND LEVELS OF DISABILITY
ASSESSED IN PREOPERATIVE EVALUATION
S. Fahimnia
1
, A. Shahrokni
2,
*, B. Korc-Grodzicki
1
1
Medicine/Geriatrics,
2
Medicine/Geriatrics and Oncology, Memorial
Sloan Kettering Cancer Center, NYC, USA
Introduction:
It is known that in general, fall is common
among community-dwelling older adults. However, not much