Effect of ECOG performance status on outcomes in patients with acute myeloid leukemia and other high-grade myeloid neoplasms

Paras, Gabrielle; Othus, Megan; Schonhoff, Kelda; Shaw, Carole; Sorror, Mohamed L.; Halpern, Anna B.; Appelbaum, Jacob; Hendrie, Paul C.; Walter, Roland B.; Estey, Elihu H.; Percival, Mary‐Elizabeth M.

doi:10.1038/s41375-022-01745-4

Cited by 3 publications

(5 citation statements)

References 15 publications

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“…The ECOG PS of patients in AML clinical trial is mainly 0–2, 30 so we wonder whether the ELN risk classification would apply to patients with higher ECOG PS patients. Our data show that patients with ECOG PS 0–1 have better OS than those with ECOG PS 2–4, which is consistent with other real‐world data and prognostic indexes reported 29,31 . When combining ECOG PS with ELN‐2022 risk classification system, the ELN‐2022 risk classification system does not work well in ECOG PS 2–4 patients; ECOG PS 2–4 patients have worse outcome than others in the ELN‐2022 favorable risk group.…”

Section: Discussionsupporting

confidence: 86%

“…ECOG performance status in newly diagnosed patients describes their level of functioning, and affects their treatment and survival, 28 , 29 but the relationship between ECOG PS and survival outcome is unclear. The ECOG PS of patients in AML clinical trial is mainly 0–2, 30 so we wonder whether the ELN risk classification would apply to patients with higher ECOG PS patients.…”

Section: Discussionmentioning

confidence: 99%

“…Our data show that patients with ECOG PS 0–1 have better OS than those with ECOG PS 2–4, which is consistent with other real‐world data and prognostic indexes reported. 29 , 31 When combining ECOG PS with ELN‐2022 risk classification system, the ELN‐2022 risk classification system does not work well in ECOG PS 2–4 patients; ECOG PS 2–4 patients have worse outcome than others in the ELN‐2022 favorable risk group. As a prognostic index in cytogenetically normal AML including ECOG PS, 31 ELN‐2022 risk classification system may also need to combine ECOG PS into risk declaration.…”

Section: Discussionmentioning

confidence: 99%

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Assessment of 2022 European LeukemiaNet risk classification system in real‐world cohort from China

Chen,

Jiao,

et al. 2023

Cancer Medicine

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BackgroundThe European LeukemiaNet (ELN) risk classification system for acute myeloid leukemia (AML) patients has been used worldwide. In 2022, the ELN risk classification system modified risk genes including CEBPA mutation status, myelodysplasia‐related (MR) gene mutations and internal tandem duplications of FLT3 (FLT3‐ITD).MethodsWe include newly diagnosed de novo AML patients at our center from January 2017 to December 2021, regardless of the further treatment received. Clinical data and date of survival were included. Survival analysis were performed using the Kaplan–Meier method, and the log‐rank test was used to compare survival between different risk groups.ResultsWe include 363 newly diagnosed de novo AML patients from 2017 to 2021 to assess the accuracy of the ELN risk classification system. Their survival results show that the ELN‐2022 risk classification system is not superior to the ELN‐2017 version; for patients with FLT3‐ITD mutations but without FLT3 inhibitor treatment, their survival is similar to the ELN‐2022 adverse risk group. The ELN‐2022 risk classification system cannot accurately clarify ECOG performance status (PS) 2–4 patients, especially in the ELN‐2022 favorable risk group.ConclusionThe ELN‐2022 risk stratification system may not be appropriate for patients unable to receive intensive therapy or FLT3 inhibitor; more real‐world data is needed to straify patients with worse ECOG PS and inferior intensive therapy.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Assessment of 2022 European LeukemiaNet risk classification system in real‐world cohort from China

Chen,

Jiao,

et al. 2023

Cancer Medicine

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“…The ECOG performance status scale is probably one of the most used in cancer, including advanced cancer. [11][12][13] In this study, an ECOG score > 1 was negatively related to survival, as in other studies. 10,11,13 The cognitive function also had a significant statistical association with survival, as patients with impaired cognition have a lower probability of living more than 1 year.…”

Section: Discussionsupporting

confidence: 85%

Factors Associated With Long Survival in Patients With Cancer Admitted to Palliative Care: An Exploratory Study

Ferraz-Gonçalves,

Alves,

Silva

et al. 2024

J Palliat Care

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Objective: Some patients with cancer admitted to palliative care have relatively long survivals of 1 year or more. The objective of this study was to find out factors associated with prolonged survival. Methods: Retrospective case-control study comparing the available data of patients with cancer who survived more than 1 year after admission in a palliative care service with patients with cancer who survived 6 months or less. The intended proportion was 4 controls for each case. Patients were identified through electronic records from 2012 until 2018. Results: And 1721 patients were identified. Of those patients, 111 (6.4%) survived for at least 1 year, and 363 (21.1%) were included as controls according to the established criteria. The intended proportion could not be reached; the proportion was only 3.3:1. The median survival of cases was 581 days (range: 371-2763), and the median survival of controls was 57 days (range: 1-182). In the multivariable analysis, patients with a hemoglobin ≥ 10.6 g/dL and a creatinine level >95 µmol/L had a higher probability of living more than 1 year. In contrast, patients with abnormal cognition, pain, anorexia, liver metastases, an Eastern Cooperative Oncology Group performance status >1, and a neutrophil/lymphocyte ratio ≥ 3.43 had a low probability of living more than 1 year. Conclusion: Several factors were statistically associated positively or negatively with prolonged survival. However, the data of this study should be confirmed in other studies.

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“…In addition, metastatic HPVpositive HNSCC often presents as low tumor-burden lung nodules with a more favorable prognosis compared to other forms of metastatic HNSCC. Higher ECOG PS has also been found to correlate with significantly shorter OS in individuals receiving pembrolizumab monotherapy, other immune checkpoint inhibitors, and other treatments for R/M HNSCC and in individuals receiving pembrolizumab monotherapy for advanced non-small cell lung cancer, as well as with a higher rate of adverse events during cancer treatment and of treatment discontinuation due to death (21, [35][36][37][38][39][40][41]. Shorter OS for oral tumors than for other HNSCC tumor sites has not generally been reported in the curative setting for R/M HNSCC (42), and this finding thus warrants further investigation of the interplay between tumor site and other baseline individual characteristics such as CPS in this treatment group.…”

Section: Discussionmentioning

confidence: 99%

Real-world treatment patterns and outcomes among individuals receiving first-line pembrolizumab therapy for recurrent/metastatic head and neck squamous cell carcinoma

et al. 2023

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BackgroundPembrolizumab, a PD-1 immune checkpoint inhibitor, is approved as first-line (1L) treatment for recurrent or metastatic head and neck squamous cell carcinoma (R/M HNSCC) as monotherapy or in combination with platinum and 5-fluorouracil chemotherapy. Limited data exist on the use of these regimens in real-world settings.ObjectiveOur primary objectives were to describe baseline characteristics and real-world overall survival (rwOS), time on treatment (rwToT), and time to next treatment (rwTTNT) among individuals with R/M HNSCC receiving approved 1L pembrolizumab therapies. We also aimed to identify baseline factors associated with choice of 1L pembrolizumab therapy and with rwOS.MethodsThis was a retrospective cohort study of adults with R/M HNSCC receiving 1L pembrolizumab monotherapy or pembrolizumab plus chemotherapy. We used Kaplan-Meier analyses to assess real-world outcomes, logistic regression modeling to identify factors associated with choice of 1L pembrolizumab therapy, and Cox proportional hazards models to identify factors associated with rwOS.ResultsThe study population included 431 individuals receiving 1L pembrolizumab monotherapy and 215 receiving 1L pembrolizumab plus chemotherapy. The use of 1L pembrolizumab monotherapy was associated with higher baseline combined positive score for PD-L1 expression, older age, higher Eastern Cooperative Oncology Group performance status (ECOG PS), laryngeal tumor site, and human papillomavirus (HPV)-positive tumor status. The pembrolizumab monotherapy group had a median (95% CI) rwOS of 12.1 (9.2–15.1) months, rwToT of 4.2 (3.5–4.6) months, and rwTTNT of 6.5 (5.4–7.4) months. Among this group, HPV-positive tumor status and lower ECOG PS were associated with longer rwOS, and oral cavity tumor site with shorter rwOS. The pembrolizumab plus chemotherapy cohort had a median (95% CI) rwOS of 11.9 (9.0–16.0) months, rwToT of 4.9 (3.8–5.6) months, and rwTTNT of 6.6 (5.8–8.3) months. In this group, HPV-positive tumor status was associated with longer rwOS.ConclusionsThis study adds to clinical trial data by summarizing real-world treatment outcomes with 1L pembrolizumab-containing therapies in a more heterogeneous population. Overall survival outcomes in both treatment groups were similar to those observed in the registration clinical trial. These findings support the use of pembrolizumab as standard of care for R/M HNSCC.

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Effect of ECOG performance status on outcomes in patients with acute myeloid leukemia and other high-grade myeloid neoplasms

Cited by 3 publications

References 15 publications

Assessment of 2022 European LeukemiaNet risk classification system in real‐world cohort from China

Assessment of 2022 European LeukemiaNet risk classification system in real‐world cohort from China

Factors Associated With Long Survival in Patients With Cancer Admitted to Palliative Care: An Exploratory Study

Real-world treatment patterns and outcomes among individuals receiving first-line pembrolizumab therapy for recurrent/metastatic head and neck squamous cell carcinoma

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