Format

Send to

Choose Destination
Biol Blood Marrow Transplant. 2019 Sep 5. pii: S1083-8791(19)30562-2. doi: 10.1016/j.bbmt.2019.08.022. [Epub ahead of print]

Functional Status as Measured by Geriatric Assessment Predicts Inferior Survival in Older Allogeneic Hematopoietic Cell Transplantation Recipients.

Author information

1
Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California.
2
Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California.
3
Division of Hematology, Department of Medicine, Stanford University, Stanford, California.
4
Division of Geriatrics, Department of Medicine, University of California San Francisco, and the San Francisco VA Medical Center, San Francisco, California.
5
Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California. Electronic address: rebecca.olin@ucsf.edu.

Abstract

Allogeneic hematopoietic cell transplantation (alloHCT) has been increasingly offered to older adults with hematologic malignancies. However, optimal methods to determine fitness for alloHCT have yet to be defined. We evaluated the ability of a comprehensive geriatric assessment (CGA) to predict post-alloHCT outcomes in a single-center prospective cohort study of patients age 50 years and older. Outcomes included overall survival (OS), progression-free survival (PFS), and nonrelapse mortality (NRM). A total of 148 patients were included, with a median age of 62 years (range, 50 to 76 years). In multivariate regression analysis, several CGA measures of functional status were predictive of post-alloHCT outcomes, after adjusting for traditional prognostic factors. Any deficit in instrumental activities of daily living (IADL) was associated with inferior OS (hazard ratio [HR], 1.81, 95% confidence interval [CI], 1.07 to 3.08; P = .03) and PFS (HR, 1.85; 95% CI, 1.15 to 2.99; P = .01). A Medical Outcomes Study Physical Health scale (MOS-PH) score <85 was associated with inferior OS (HR, 1.96; 95% CI, 1.13 to 3.40; P = .02), PFS (HR, 1.75; 95% CI, 1.07 to 2.88; P = .03), and increased NRM (subdistribution HR, 2.57; 95% CI, 1.12 to 5.92; P = .03). MOS-PH score was also associated with the number of non-hematologic grade ≥3 adverse events within the first 100 days after alloHCT (rate ratio, 1.61; 95% CI, 1.04 to 2.49; P = .03). These findings support previous work suggesting that IADL is an important prognostic tool prior to alloHCT. MOS-PH is newly identified as an additional metric to identify older patients at higher risk of poor post-alloHCT outcomes, including toxicity and NRM.

KEYWORDS:

Allogeneic transplantation; Functional status; Geriatric assessment

PMID:
31493541
DOI:
10.1016/j.bbmt.2019.08.022

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center