Comprehensive geriatric assessment may help refine azacytidine targets in MDS

In elderly adults with myelodysplastic syndrome (MDS), the comprehensive geriatric assessment (CGA) can detect geriatric-related health issues and may be useful in identifying those unlikely to benefit from azacytidine treatment, a recent study has shown.

The researchers performed a prospective study on 98 elderly MDS patients (median age at diagnosis, 76 years; 62 males), in whom the burden of geriatric-related health issues was assessed using the CGA. The duration of azacytidine treatment and patient survival were compared between groups with vs without CGA deficits.

Majority (78 percent; n=77) of the participants had deficits in at least one CGA domain; 56 percent (n=55) and 39 percent (n=38) had deficits in two and three domains, respectively. A third (34 percent; n=33) had at least one deficit in instrumental activities of daily living (iADL), suggesting that these patients were dependent on others for tasks such as food preparation, medication and finances.

Patients who were dependent for iADLs were also found to have completed significantly fewer cycles of azacytidine (mean, 3.7±2.6 vs 12.1±7.9; p=0.005). Those with cognitive impairment (3.5±2.1 vs 10.9±7.9; p=0.034) and abnormal Timed Get Up and Go results (3.8±2.5 vs 13.2±7.8; p=0.001) likewise completed a significantly lower number of azacytidine cycles.

In turn, this led to worse survival outcomes. Patients who were unable to complete six cycles of azacytidine treatment had significantly shorter median overall survival than their counterparts who had taken at least six cycles (5.5 vs 18 months; p=0.005).