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

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.

Keywords:

• Acute myeloid leukemia
• frailty
• veterans
• electronic frailty index
• overall survival
• geriatric oncology

Acknowledgements

We thank the Department of Veterans Affairs and the Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC) group that made it possible for this work to be conducted.

Author contributions

Conception and design: Michelle H. Lee, Jennifer La, Jane A. Driver, and Clark Dumontier. Administrative support: Michelle H. Lee, Jennifer La, Nathanael Fillmore, and Clark Dumontier. Provision of study materials or patients: Jennifer La and Nathanael Fillmore. Collection and assembly of data: Michelle H. Lee and Jennifer La. Data analysis and interpretation: Michelle H. Lee, Jennifer La, Nathanael Fillmore, and Clark Dumontier. Manuscript writing: Michelle H. Lee and Clark Dumontier. Final editing and approval of manuscript: all authors.

Disclosure statement

The authors report there are no competing interests to declare.

Data availability statement

The datasets analyzed in this study will be available from the corresponding author upon reasonable request.

Additional information

Funding

This work was supported by the VA Office of Research and Development, Cooperative Studies Program; VA Career Development Award, under Grant/Award Number: IK2CX002218; American Heart Association, Grant/Award Number: 857078.