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

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 vulnerabil...

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Bibliographic Details
Published in:Bone marrow transplantation (Basingstoke) 2020-01, Vol.55 (1), p.157-164
Main Authors: Lin, Richard J., Elko, Theresa A., Devlin, Sean M., Shahrokni, Armin, Jakubowski, Ann A., Dahi, Parastoo B., Perales, Miguel-Angel, Tamari, Roni, Shaffer, Brian C., Sauter, Craig S., Papadopoulos, Esperanza B., Gyurkocza, Boglarka, Korc-Grodzicki, Beatriz, Barker, Juliet N., Maloy, Molly A., Giralt, Sergio A.
Format: Article
Language:English
Subjects:
692/308/174
692/699/1541/1990/283/1897
Activities of daily living
Aged patients
Biochemical markers
Blood cancer
Cancer
Cell Biology
Cell death
Clinical trials
Complications
Domains
Geriatrics
Health risks
Hematology
Hematopoietic stem cells
Impairment
Internal Medicine
Medical research
Medicine
Medicine & Public Health
Medicine, Experimental
Mood
Mortality
New York
Nutrition
Patient outcomes
Public Health
Renal function
Stem cell transplantation
Stem Cells
Survival
Transplantation
Transplants & implants
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Summary: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.
ISSN:0268-3369
1476-5365
DOI:10.1038/s41409-019-0654-6