End-of-life care for older AML patients relapsing after allogeneic stem cell transplant at a dedicated cancer center Journal Article


Authors: Lin, R. J.; Elko, T. A.; Perales, M. A.; Alexander, K.; Jakubowski, A. A.; Devlin, S. M.; Dahi, P. B.; Papadopoulos, E. B.; Klimek, V. M.; Giralt, S. A.; Nelson, J. E.
Article Title: End-of-life care for older AML patients relapsing after allogeneic stem cell transplant at a dedicated cancer center
Abstract: Older patients with acute myelogenous leukemia (AML) are at increased risk for mortality and morbidity. While allogeneic stem cell transplantation may provide cure in some patients, many still relapse after transplant and are then left with limited therapeutic options and poor survival. Moreover, the quality of the end-of-life care for these patients has not been previously reported. We describe here the end-of-life experience of a cohort of 72 older patients with AML who relapsed after first allogeneic stem cell transplant at our dedicated cancer center. Despite a median overall survival of only 4 months, we find a high level of primary palliative care delivered by transplant/leukemia physicians through goals of care discussions and/or advanced care planning and provide evidence for high-quality end-of-life care outcomes, often with concurrent disease-directed therapy. Our results compare favorably with end-of-life care outcomes reported for older AML patients, including those who did not undergo transplant. Given the poor prognosis and unique underlying vulnerabilities in this high-risk patient population, incorporating timely advanced care planning and palliative care delivery while exploring available salvage options may further improve end-of-life care outcomes. © 2018, Springer Nature Limited.
Keywords: adult; cancer survival; aged; major clinical study; overall survival; allogeneic stem cell transplantation; cancer palliative therapy; retrospective study; cancer mortality; health care quality; survival time; intensive care unit; hospital admission; terminal care; high risk population; leukemia relapse; vulnerable population; hospital mortality; clinical outcome; acute myeloid leukemia; advance care planning; cancer prognosis; human; male; female; priority journal; article; do not resuscitate order
Journal Title: Bone Marrow Transplantation
Volume: 54
Issue: 5
ISSN: 0268-3369
Publisher: Nature Publishing Group  
Date Published: 2019-05-01
Start Page: 700
End Page: 706
Language: English
DOI: 10.1038/s41409-018-0311-5
PUBMED: 30135464
PROVIDER: scopus
DOI/URL:
Notes: Article -- Source: Scopus
Altmetric Score
MSK Authors
  1. Virginia Klimek
    115 Klimek
  2. Sergio Andres Giralt
    546 Giralt
  3. Miguel-Angel Perales
    387 Perales
  4. Sean McCarthy Devlin
    309 Devlin
  5. Parastoo Bahrami Dahi
    90 Dahi
  6. Judith Eve Nelson
    33 Nelson
  7. Richard Jirui Lin
    12 Lin
  8. Theresa Ann Elko
    4 Elko