Do quality of life, physical function, or the Wheatley index at diagnosis predict 1-year mortality with intensive chemotherapy in older acute myeloid leukemia patients?

Treatment decision-making is complicated in older adults with acute myeloid leukemia (AML) because of poor prognosis and significant treatment toxicities. Improved prognostication at the time of diagnosis, such as with the Wheatley Index, may aid clinical decision-making. Pre-treatment quality of life (QOL) or objective physical performance measures (PPMs) may also predict outcomes such as mortality in oncology. We investigated the predictive value of the Wheatley Index, QOL and PPMs at diagnosis on one-year mortality in older (60+ years) AML patients undergoing intensive chemotherapy (IC) in a large AML referral center. AML patients undergoing IC were enrolled in a single-center prospective study. The Wheatley prognostic risk category (good, standard and poor) was determined. Predictors of one-year mortality were assessed with logistic regression. Overall one-year mortality was 37.1%. QOL and PPMs at diagnosis were not good predictors of one-year mortality. Poor Wheatley risk category was the strongest predictor in both univariate and multivariable mortality models (adjusted odds ratio 7.1, 95% confidence interval 1.95-25.5, p<0.001). The Wheatley index may be useful to clinicians and patients by providing an integrated prognostic tool to guide up-front therapy in AML.