{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T09:13:25Z","timestamp":1788513205904,"version":"build-2803163510"},"reference-count":79,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T00:00:00Z","timestamp":1779667200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T00:00:00Z","timestamp":1779667200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["European J of Haematology"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Acute Myeloid Leukemia predominantly affects older adults, who often present with comorbidities, functional impairment, and frailty, limiting eligibility for intensive chemotherapy or allogeneic transplantation. Historically, treatment options were restricted to hypomethylating agents, low\u2010dose cytarabine, hydroxyurea, or supportive care, with poor outcomes. The introduction of hypomethylating agents combined with Venetoclax and the availability of targeted therapies have expanded therapeutic possibilities, challenging the notion that elderly AML is uniformly incurable. In this evolving context, accurate assessment of fitness and frailty is essential to guide treatment decisions. This review summarizes current concepts of frailty in older AML patients, including general geriatric tools and hematology\u2010specific indices. It discusses the role of Comprehensive Geriatric Assessment, frailty phenotypes, and comorbidity scores such as the transplantation\u2010specific comorbidity index and the Charlson index, alongside AML\u2010focused tools like the Ferrara criteria and integrated molecular risk models. Most existing tools were developed in intensively treated cohorts, and their applicability to patients receiving non\u2010intensive regimens remains uncertain. Fitness is increasingly recognized as a dynamic, multidimensional construct incorporating clinical, functional, cognitive, social, and biological factors. A multiparametric approach is proposed, integrating these variables into decision\u2010making models, potentially enhanced by artificial intelligence to optimize treatment selection in older AML patients.<\/jats:p>","DOI":"10.1111\/ejh.70223","type":"journal-article","created":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T01:46:08Z","timestamp":1779759968000},"page":"787-798","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Frailty and Fitness in Older Adults With Acute Myeloid Leukemia: From Chronological Age to Multiparametric Assessment"],"prefix":"10.1111","volume":"117","author":[{"given":"Antonella","family":"Bruzzese","sequence":"first","affiliation":[{"name":"Hematology Unit, Department of Onco\u2010Hematology AO of Cosenza  Cosenza Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enrica Antonia","family":"Martino","sequence":"additional","affiliation":[{"name":"Hematology Unit, Department of Onco\u2010Hematology AO of Cosenza  Cosenza Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Santino","family":"Caserta","sequence":"additional","affiliation":[{"name":"Hematology Unit, Department of Onco\u2010Hematology AO of Cosenza  Cosenza Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Eugenia","family":"Alvaro","sequence":"additional","affiliation":[{"name":"Hematology Unit, Department of Onco\u2010Hematology AO of Cosenza  Cosenza Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola","family":"Amodio","sequence":"additional","affiliation":[{"name":"Department of Experimental and Clinical Medicine University of Catanzaro  Catanzaro Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eugenio","family":"Lucia","sequence":"additional","affiliation":[{"name":"Hematology Unit, Department of Onco\u2010Hematology AO of Cosenza  Cosenza Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Virginia","family":"Olivito","sequence":"additional","affiliation":[{"name":"Hematology Unit, Department of Onco\u2010Hematology AO of Cosenza  Cosenza Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caterina","family":"Labanca","sequence":"additional","affiliation":[{"name":"Hematology Unit, Department of Onco\u2010Hematology AO of Cosenza  Cosenza Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6339-632X","authenticated-orcid":false,"given":"Francesco","family":"Mendicino","sequence":"additional","affiliation":[{"name":"Hematology Unit, Department of Onco\u2010Hematology AO of Cosenza  Cosenza Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fortunato","family":"Morabito","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Health and Nutritional Science University of Calabria  Rende Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ernesto","family":"Vigna","sequence":"additional","affiliation":[{"name":"Hematology Unit, Department of Onco\u2010Hematology AO of Cosenza  Cosenza Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5256-0726","authenticated-orcid":false,"given":"Massimo","family":"Gentile","sequence":"additional","affiliation":[{"name":"Hematology Unit, Department of Onco\u2010Hematology AO of Cosenza  Cosenza Italy"},{"name":"AIL Sezione di Cosenza  Cosenza Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,25]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood\u20102016\u201008\u2010733196"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.27625"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2012971"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood\u20102018\u201008\u2010868752"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00277\u2010021\u201004465\u20104"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood.2022016867"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2013.54.8347"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.2147\/CIA.S191117"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.14301"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jgo.2015.10.182"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.3390\/cancers10070225"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1182\/asheducation\u20102016.1.339"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood\u20102012\u201012\u2010471680"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.26079"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood.2019000758"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1038\/leu.2012.303"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1182\/bloodadvances.2024013744"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1093\/gerona\/59.3.m255"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12603\u2010020\u20101491\u20104"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1007\/978\u20103\u2010662\u201040455\u20103_5"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/0140\u20106736(93)92884\u2010v"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdr587"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1093\/gerona\/56.3.m146"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1532\u20105415.2001.49281.x"},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.050051"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood.V130.Suppl_1.861.861"},{"key":"e_1_2_8_28_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00432\u2010007\u20100233\u2010x"},{"key":"e_1_2_8_29_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1754\u20104505.2009.00088.x"},{"key":"e_1_2_8_30_1","doi-asserted-by":"publisher","DOI":"10.1080\/10428194.2017.1347930"},{"key":"e_1_2_8_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbmt.2012.11.006"},{"key":"e_1_2_8_32_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.20.01392"},{"key":"e_1_2_8_33_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood\u20102005\u201005\u20102004"},{"key":"e_1_2_8_34_1","doi-asserted-by":"publisher","DOI":"10.1182\/bloodadvances.2025017089"},{"key":"e_1_2_8_35_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.19022"},{"key":"e_1_2_8_36_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41408\u2010025\u201001324\u20107"},{"key":"e_1_2_8_37_1","doi-asserted-by":"publisher","DOI":"10.3390\/jpm16040200"},{"key":"e_1_2_8_38_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.13476"},{"key":"e_1_2_8_39_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood\u20102007\u201006\u2010096966"},{"key":"e_1_2_8_40_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365\u20102141.2006.06476.x"},{"key":"e_1_2_8_41_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2017.2714"},{"key":"e_1_2_8_42_1","doi-asserted-by":"publisher","DOI":"10.1016\/0021\u20109681(87)90171\u20108"},{"key":"e_1_2_8_43_1","doi-asserted-by":"publisher","DOI":"10.1016\/0895\u20104356(92)90133\u20108"},{"key":"e_1_2_8_44_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clml.2020.07.002"},{"key":"e_1_2_8_45_1","doi-asserted-by":"publisher","DOI":"10.1038\/leu.2014.234"},{"key":"e_1_2_8_46_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2023-189322"},{"key":"e_1_2_8_47_1","doi-asserted-by":"publisher","DOI":"10.1200\/JOP.18.00180"},{"key":"e_1_2_8_48_1","doi-asserted-by":"publisher","DOI":"10.1111\/ejh.13570"},{"key":"e_1_2_8_49_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood.2021013671"},{"key":"e_1_2_8_50_1","doi-asserted-by":"publisher","DOI":"10.3324\/haematol.2012.067892"},{"key":"e_1_2_8_51_1","doi-asserted-by":"publisher","DOI":"10.1182\/bloodadvances.2021006872"},{"key":"e_1_2_8_52_1","doi-asserted-by":"publisher","DOI":"10.1097\/CM9.0000000000000645"},{"key":"e_1_2_8_53_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jgo.2025.102219"},{"key":"e_1_2_8_54_1","doi-asserted-by":"publisher","DOI":"10.1002\/hon.70166"},{"key":"e_1_2_8_55_1","doi-asserted-by":"publisher","DOI":"10.1111\/ejh.70058"},{"key":"e_1_2_8_56_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41409\u2010023\u201002088\u2010z"},{"key":"e_1_2_8_57_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtct.2026.01.026"},{"key":"e_1_2_8_58_1","doi-asserted-by":"publisher","DOI":"10.1093\/gerona\/gly232"},{"key":"e_1_2_8_59_1","doi-asserted-by":"publisher","DOI":"10.1080\/10428194.2023.2254434"},{"key":"e_1_2_8_60_1","doi-asserted-by":"publisher","DOI":"10.3390\/cancers15041002"},{"key":"e_1_2_8_61_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2011.35.7525"},{"key":"e_1_2_8_62_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood\u20102010\u201003\u2010276485"},{"key":"e_1_2_8_63_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2002.20.2.494"},{"key":"e_1_2_8_64_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jgo.2021.09.007"},{"key":"e_1_2_8_65_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.critrevonc.2009.06.003"},{"key":"e_1_2_8_66_1","doi-asserted-by":"publisher","DOI":"10.6004\/jnccn.2021.7033"},{"key":"e_1_2_8_67_1","doi-asserted-by":"publisher","DOI":"10.17294\/2330\u20100698.1951"},{"key":"e_1_2_8_68_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2017.7156"},{"key":"e_1_2_8_69_1","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djx029"},{"key":"e_1_2_8_70_1","doi-asserted-by":"publisher","DOI":"10.1182\/bloodadvances.2021005538"},{"key":"e_1_2_8_71_1","doi-asserted-by":"publisher","DOI":"10.1182\/bloodadvances.2022007265"},{"key":"e_1_2_8_72_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41408\u2010024\u201001130\u20107"},{"key":"e_1_2_8_73_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood.2024025409"},{"key":"e_1_2_8_74_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.20.01632"},{"key":"e_1_2_8_75_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1902688"},{"key":"e_1_2_8_76_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.23.01911"},{"key":"e_1_2_8_77_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood.2021014586"},{"key":"e_1_2_8_78_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.leukres.2024.107518"},{"key":"e_1_2_8_79_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.26601"},{"key":"e_1_2_8_80_1","doi-asserted-by":"publisher","DOI":"10.3324\/haematol.2023.284085"}],"container-title":["European Journal of Haematology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ejh.70223","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/ejh.70223","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ejh.70223","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T08:22:48Z","timestamp":1788510168000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ejh.70223"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,25]]},"references-count":79,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.1111\/ejh.70223"],"URL":"https:\/\/doi.org\/10.1111\/ejh.70223","archive":["Portico"],"relation":{},"ISSN":["0902-4441","1600-0609"],"issn-type":[{"value":"0902-4441","type":"print"},{"value":"1600-0609","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,25]]},"assertion":[{"value":"2026-04-22","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-11","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-25","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}