A newly developed screening tool, HEMA-4, effectively predicted survival among older patients with malignant hemopathies. These findings, from a prospective study, were published in the Journal of Geriatric Oncology.

This study was conducted to develop and validate a simple score to estimate survival in patients 65 years and older with malignant hemopathies referred for chemotherapy. For the development cohort, 206 patients were recruited at the Institut Jules Bordet and University Hospitals Leuven in Belgium between 2009 and 2018. All patients underwent a 1-hour screening test comprising multiple validated instruments and standard laboratory assessments. An independent validation cohort of 25 patients was recruited to test the predictive power of HEMA-4.

Patients were median age 76 years (range, 65 to 90) and 54% were men. Diagnoses included diffuse large B cell lymphoma (43%), multiple myeloma (15%), acute myeloid leukemia (11%), or chronic lymphocytic leukemia (10%).

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Survival at 1 year was associated with 4 prognostic markers: Comorbidities, particularly a history of peptic ulcer; cognitive status; albumin level; and inflammation.

On the basis of these significant associations and the correlations between individual characteristics, the investigators derived the HEMA-4 tool. Patients were given 1 point for each of the final variables: Mini Mental State Examination (MMSE) score less than 27, 2 or more comorbidities, albumin level <35 g/L, and serum C-reactive protein concentration ≥10 mg/L. Scores of 3 to 4 indicated poor prognosis; 2, intermediate; and 0 to 1, good prognosis.

One-year survival rates for patients who had poor prognosis was 36%; for those with an intermediate prognosis, it was 51%; and those with a good prognosis had a 74% survival rate. Among the validation cohort, survival was 10%, 50%, and 78% for the poor, intermediate, and good prognosis cohorts, respectively.

This study was limited by its small sample size of the independent validation cohort.

The 4-item screening tool, HEMA-4, effectively predicted 1-year survival in patients 65 and older with malignant hemopathies referred for chemotherapy regardless of their chronological age, the study authors concluded.


Thibaud V, Denève L, Dubruille S, et al. Identifying frailty in clinically fit patients diagnosed with hematological malignancies using a simple clinico-biological screening tool: The HEMA-4 study. J Geriatr Oncol. 2021;S1879-4068(21)00043-6. doi:10.1016/j.jgo.2021.02.019