Impact of geriatric vulnerabilities on allogeneic hematopoietic cell transplantation outcomes in older patients with hematologic malignancies Journal Article

Authors: Lin, R. J.; Elko, T. A.; Devlin, S. M.; Shahrokni, A.; Jakubowski, A. A.; Dahi, P. B.; Perales, M. A.; Tamari, R.; Shaffer, B. C.; Sauter, C. S.; Papadopoulos, E. B.; Gyurkocza, B.; Korc-Grodzicki, B.; Barker, J. N.; Maloy, M. A.; Giralt, S. A.
Article Title: Impact of geriatric vulnerabilities on allogeneic hematopoietic cell transplantation outcomes in older patients with hematologic malignancies
Abstract: Older patients are at increased risk for complications and death following allogeneic hematopoietic cell transplantation (allo-HCT). Traditional transplant-specific prognostic indices such as hematopoietic cell transplant comorbidity index (HCT-CI) may not capture all underlying geriatric vulnerabilities, and in-depth evaluation by a geriatrician prior to transplant may not always be available. We hypothesize that routine pretransplant interdisciplinary clinical assessment may uncover prognostically important geriatric deficits. Using an institutional database of 457 adults aged 60 years and older who underwent first allo-HCT for hematological malignancies from 2010 to 2017, we examined the prognostic impact of pretransplant deficits in geriatric domains of function, mobility, mood, medication, nutrition, and relevant biochemical markers. We found that impairment in instrumental activities of daily living (IADL) was associated with reduced survival through increased nonrelapse mortality (NRM, HR = 1.82; 95% CI, 1.04–3.19). The combination of IADL impairment with either HCT-CI/age index or disease risk index readily stratified NRM and overall survival, respectively. In addition, we found that even mild renal dysfunction adversely impacted survival in older transplant patients. Our findings establish important geriatric vulnerabilities in older patients prior to allo-HCT and may provide an entry point for prospective, interventional trials to improve their outcomes. © 2019, The Author(s), under exclusive licence to Springer Nature Limited.
Keywords: adult; cancer survival; aged; human cell; major clinical study; overall survival; cancer recurrence; preoperative evaluation; clinical assessment; data base; cancer mortality; age; disease severity; hematologic malignancy; allogeneic hematopoietic stem cell transplantation; daily life activity; mood disorder; immunosuppressive agent; geriatric assessment; functional disease; kidney dysfunction; clinical outcome; walking difficulty; biochemical composition; hematological parameters; cancer prognosis; nutritional disorder; human; male; female; priority journal; article
Journal Title: Bone Marrow Transplantation
Volume: 55
Issue: 1
ISSN: 0268-3369
Publisher: Nature Publishing Group  
Date Published: 2020-01-01
Start Page: 157
End Page: 164
Language: English
DOI: 10.1038/s41409-019-0654-6
PUBMED: 31471572
PROVIDER: scopus
PMCID: PMC6940509
Notes: Article -- Source: Scopus
Citation Impact
MSK Authors
  1. Sergio Andres Giralt
    578 Giralt
  2. Craig Steven Sauter
    184 Sauter
  3. Miguel-Angel Perales
    421 Perales
  4. Juliet N Barker
    239 Barker
  5. Molly Anna Maloy
    150 Maloy
  6. Sean McCarthy Devlin
    332 Devlin
  7. Parastoo Bahrami Dahi
    106 Dahi
  8. Roni Tamari
    86 Tamari
  9. Brian Carl Shaffer
    55 Shaffer
  10. Richard Jirui Lin
    16 Lin
  11. Theresa Ann Elko
    6 Elko