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Biol Blood Marrow Transplant. 2019 Jun;25(6):1218-1224. doi: 10.1016/j.bbmt.2019.01.028. Epub 2019 Jan 30.

Limitation in Patient-Reported Function Is Associated with Inferior Survival in Older Adults Undergoing Autologous Hematopoietic Cell Transplantation.

Author information

1
Memorial Sloan Kettering Cancer Center, New York, New York.
2
Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California.
3
Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California. Electronic address: rebecca.olin@ucsf.edu.

Abstract

Although the use of geriatric assessment (GA) in the allogeneic hematopoietic cell transplantation (HCT) setting has been reported, few studies have evaluated the impact of patient-reported function on autologous HCT (autoHCT) outcomes. In this study, GA, including the administration of Functional Assessment of Cancer Therapy-Bone Marrow Transplant (FACT-BMT) quality of life tool, was performed in 184 patients age ≥50 years (median age, 61 years; range, 50 to 75 years) before autoHCT. Associations among GA findings, quality of life metrics, and post-transplantation outcomes were evaluated using Cox regression. Indications for autoHCT included multiple myeloma (73%), non-Hodgkin lymphoma (20%), and other disorders (7%). The median progression-free survival (PFS) was 28 months, whereas the median overall survival (OS) was not reached. In unadjusted analysis, both PFS and OS were significantly associated with 5 GA components: limitation in instrumental activities of daily living, patient-reported Karnofsky Performance Status (KPS), and the Physical, Functional, and BMT subscale scores of the FACT-BMT. In multivariate analysis, 3 components-limitation in instrumental activities of daily living, patient-reported KPS, and FACT-BMT Physical subscale-remained predictive of both PFS and OS when adjusted for age, provider-reported KPS, disease status, and HCT comorbidity index. In older adults undergoing autoHCT, limitation in any 1 of 3 patient-reported measures of functional status was independently associated with inferior PFS and OS, even after adjusting for known prognostic factors.

KEYWORDS:

Autologous transplantation; Functional status; Geriatric assessment

PMID:
30708189
DOI:
10.1016/j.bbmt.2019.01.028

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