Baseline correlates of frailty and its association with survival in United States veterans with acute myeloid leukemia.

Summary

A high proportion of veterans with acute myeloid leukemia are classified as frail, and those with moderate to severe frailty experience significantly shorter survival times. Incorporating a frailty index into standard risk models provides a more accurate prognosis than using genetic risk classifications alone.

Key result

Moderate-to-severely frail veterans with acute myeloid leukemia exhibited significantly shorter median survival than mildly frail and non-frail veterans (179 vs. 306 vs. 417 days, p < .001).

Abstract

Frailty is an important construct to measure in acute myeloid leukemia (AML). We used the Veterans Affairs Frailty Index (VA-FI) - calculated using readily available data within the VA's electronic health records - to measure frailty in U.S. veterans with AML. Of the 1166 newly diagnosed and treated veterans with AML between 2012 and 2022, 722 (62%) veterans with AML were classified as frail (VA-FI > 0.2). At a median follow-up of 252.5 days, moderate-severely frail veterans had significantly worse survival than mildly frail, and non-frail veterans (median survival 179 vs. 306 vs. 417 days, p < .001). Increasing VA-FI severity was associated with higher mortality. A model with VA-FI in addition to the European LeukemiaNet (ELN) risk classification and other covariates statistically outperformed a model containing the ELN risk and other covariates alone (p < .001). These findings support the VA-FI as a tool to expand frailty measurement in research and clinical practice for informing prognosis in veterans with AML.

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