Burden and impact of multifactorial geriatric syndromes in allogeneic hematopoietic cell transplantation for older adults Journal Article


Authors: Lin, R. J.; Hilden, P. D.; Elko, T. A.; Dahi, P. B.; Shahrokni, A.; Jakubowski, A. A.; Perales, M. A.; Sauter, C. S.; Castro-Malaspina, H. R.; Barker, J. N.; Shaffer, B. C.; Tamari, R.; Papadopoulos, E. B.; Maloy, M. A.; Korc-Grodzicki, B.; Giralt, S. A.
Article Title: Burden and impact of multifactorial geriatric syndromes in allogeneic hematopoietic cell transplantation for older adults
Abstract: Multifactorial geriatric syndromes are highly prevalent in older patients with cancer. Because an increasing number of older patients undergo allogeneic hematopoietic stem cell transplantation (allo-HCT), we examined the incidence and impact of transplant-related geriatric syndromes using our institutional database and electronic medical records. We identified 527 patients age 60 years or older who had undergone first allo-HCT from 2001 to 2016 for hematologic malignancies. From the initiation of conditioning to 100 days posttransplant, new geriatric syndromes were predominantly delirium with a cumulative incidence of 21% (95% confidence interval [CI], 18%-25%) at day 100 followed by fall at 7% (95% CI, 5%-9%). In multivariable analyses of available pretransplant variables, fall within the last year, potentially inappropriate use of medication, thrombocytopenia, and reduced creatinine clearance were significantly associated with delirium; age older than 70 years and impaired activities of daily living were significantly associated with fall. In the 100-day landmark analysis, both delirium (hazard ratio [HR], 1.66; 95% CI, 1.09-2.52; P = .023) and fall (HR, 2.14; 95% CI, 1.16-3.95; P = .026) were significantly associated with increased nonrelapse mortality; moreover, fall (HR, 1.93; 95% CI, 1.18-3.14; P = .016), but not delirium, was significantly associated with reduced overall survival. Here, we establish baseline incidences and risk factors of common transplant-related geriatric syndromes. Importantly, we demonstrate significant associations of delirium and fall with inferior transplant outcomes. The burden and impact of transplant-related geriatric syndromes warrant the institution of patient-centered, preemptive, longitudinal, and multidisciplinary interventions to improve outcomes for older allo-HCT patients. © 2019 by The American Society of Hematology.
Journal Title: Blood Advances
Volume: 3
Issue: 1
ISSN: 2473-9529
Publisher: American Society of Hematology  
Date Published: 2019-01-08
Start Page: 12
End Page: 20
Language: English
DOI: 10.1182/bloodadvances.2018028241
PUBMED: 30606722
PROVIDER: scopus
PMCID: PMC6325300
DOI/URL:
Notes: Article -- Export Date: 1 February 2019 -- Source: Scopus
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MSK Authors
  1. Sergio Andres Giralt
    965 Giralt
  2. Craig Steven Sauter
    332 Sauter
  3. Miguel-Angel Perales
    820 Perales
  4. Juliet N Barker
    333 Barker
  5. Molly Anna Maloy
    267 Maloy
  6. Parastoo Bahrami Dahi
    253 Dahi
  7. Roni Tamari
    198 Tamari
  8. Patrick Dale Hilden
    107 Hilden
  9. Armin Shahrokni
    130 Shahrokni
  10. Brian Carl Shaffer
    142 Shaffer
  11. Richard Jirui Lin
    89 Lin
  12. Theresa Ann Elko
    21 Elko