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
Notes: Article -- Export Date: 1 February 2019 -- Source: Scopus
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MSK Authors
  1. Sergio Andres Giralt
    499 Giralt
  2. Craig Steven Sauter
    151 Sauter
  3. Miguel-Angel Perales
    354 Perales
  4. Juliet N Barker
    220 Barker
  5. Molly Anna Maloy
    118 Maloy
  6. Parastoo Bahrami Dahi
    74 Dahi
  7. Roni Tamari
    72 Tamari
  8. Patrick Dale Hilden
    79 Hilden
  9. Brian Carl Shaffer
    40 Shaffer
  10. Richard Jirui Lin
    5 Lin
  11. Theresa Ann Elko
    1 Elko