Geriatric Assessment Identifies Impairments in Younger Candidates for Allogeneic Hematopoietic Stem Cell Transplantation

• Published in: Blood 2019-11, Vol.134 (Supplement_1), p.1984-1984
• Main Authors: Lew, Meagan V., Ren, Yi, Lowder, Yen P., Romero, Kristi M., Thompson, Jillian C., Bohannon, Lauren M., Cohen, Harvey, Bartlett, David A., Pastva, Amy M., Morey, Miriam, Hall, Katherine, Smith, Patrick, Peters, Katherine B., Somers, Tamara, Kelleher, Sarah, Smith, Sophia, Wischmeyer, Paul, Lin, Pao-Hwa, Thorpe, Glynnis, Minor, Kerry, Adler, Allison, Wiggins, Kristi, Hennig, Therese, Helms, Tanya, Welch, Renee, Hicks, Whitney, Eren, Margaret, Porter, Rebecca, Matthews, Brittany, Liu, JoAnn, Burleson, Jill, Andrew, Whitney, Aberant, Thomas, Engemann, Ashley K., Henshall, Bethany, Darby, Maurisa, Valea, Renea, Proch, Christina, Dellascio, Michelle, Pittman, Alyssa, Choi, Taewoong, Gasparetto, Cristina, Long, Gwynn D., Lopez, Richard D., Rizzieri, David A., Sarantopoulos, Stefanie, Horwitz, Mitchell E., Chao, Nelson J., Sung, Anthony D.
• Format: Article
• Language: English
• ISSN: 0006-4971; 1528-0020
• DOI: 10.1182/blood-2019-127264

Introduction: Geriatric assessment (GA) is a multidimensional evaluation of patient health and function that may detect impairments not identified as part of routine care, predict treatment-related morbidity and mortality, and inform treatment plans. Given evidence of these benefits, the National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology (NCCN Guidelines®) recommend GA for older candidates of hematopoietic stem cell transplantation (HCT). However, both older and younger HCT candidates will often receive multiple rounds of chemotherapy before HCT, leading to functional impairments in all age groups. Furthermore, HCT patients often experience a significant gap between when they are first evaluated and actually proceed to transplant (e.g., while a donor search is conducted), creating an opportunity to identify impairments and optimize function prior to transplant. Methods: To address this opportunity, we created a clinical pre-HCT optimization program (C-POP) to evaluate physical function, cognitive function, nutritional status, and mental health in all adults who were deemed potential candidates for allogeneic HCT by a HCT physician. We applied this standard of care program to all adult candidates for HCT, regardless of age, with the goal of identifying functional impairments and then referring patients to services to optimize those impairments prior to HCT. We defined impairments using validated measures and compared results to established norms or scoring, controlling for age and gender where appropriate (e.g., the cut-off for six-minute walk distance was adjusted for age, gender, height, and weight, while the cut-off for falls was any fall regardless of characteristics). Patients with impairments were referred to the appropriate supportive care (e.g., physical function impairment -> referral to physical therapy). Results were prospectively analyzed at new patient evaluation (NPE), which was the first time the patient met a HCT physician and sign-off, which occurred within a week before starting transplant. While the program is ongoing, we present here the results of patients evaluated between October 16th, 2017 and July 1st, 2019. Patients are divided into three pre-specified age groups: =60 years old, with results compared using a chi-squared test. Results: We evaluated 115 patients: 21 (18%) =60 years). There were no differences between the ag