Geriatric Assessment Reveals Actionable Impairments in Hematopoietic Stem Cell Transplantation Candidates Age 18 to 80 Years.
Journal Article (Journal Article)
Allogeneic hematopoietic stem cell transplantation (HCT) is a potentially curative treatment for both malignant and nonmalignant hematologic diseases; however, reported rates of treatment-related mortality approach 30%. Outcomes are worse in patients who begin HCT with functional impairments. To detect such impairments, a geriatric assessment (GA) is recommended in adults age ≥65 years. Younger HCT candidates also may be impaired because of chemotherapy regimens pre-HCT. Therefore, we hypothesized that GA can be beneficial for adult patients of all ages and subsequently created a clinical pretransplantation optimization program to assess all HCT candidates using a modified GA. One-hundred fifty-seven patients were evaluated in 4 functional domains- physical, cognitive, nutritional, and psychological-at 2 time points prior to HCT-new patient evaluation (NPE) and sign-off (SO)-between October 2017 and January 2020. At NPE, 80.9% of the patients had at least 1 domain with a functional impairment, and physical (P = .006), cognitive (P = .04), and psychological (P = .04) impairments were associated with an increased likelihood of not proceeding to HCT. In addition, patients age 18 to 39 years were more likely than older patients to have a physical function impairment (P = .001). Between NPE and SO, 51.9% of the patients had resolution of 1 or more impairments, and nutritional impairment at SO was predictive of worse overall survival (P = .01). Our study shows that GA can identify functional impairments in patients of all ages. Early identification of impairments could facilitate referrals to supportive care and resolution of impairments prior to HCT, suggesting that GA could be recommended for HCT candidates of all ages.
Full Text
Duke Authors
- Bartlett, David Bruce
- Burleson, Jill
- Chao, Nelson Jen An
- Choi, Taewoong
- Cohen, Harvey Jay
- Gasparetto, Cristina
- Hall, Katherine Shepherd
- Horwitz, Mitchell Eric
- Kelleher, Sarah Anne
- Long, Gwynn Douglas
- Lopez, Richard D
- Morey, Miriam C.
- Pastva, Amy Martha
- Sarantopoulos, Stefanie
- Somers, Tamara J.
- Wischmeyer, Paul Edmund
Cited Authors
- Lew, MV; Ren, Y; Lowder, YP; Siamakpour-Reihani, S; Ramalingam, S; Romero, KM; Thompson, JC; Bohannon, LM; McIntyre, J; Tang, H; Van Opstal, J; Johnson, E; Cohen, HJ; Bartlett, DB; Pastva, AM; Morey, M; Hall, KS; Smith, P; Peters, KB; Somers, TJ; Kelleher, S; Smith, SK; Wischmeyer, PE; Lin, P-H; Wood, WA; Thorpe, G; Minor, K; Wiggins, K; Hennig, T; Helms, T; Welch, R; Matthews, B; Liu, J; Burleson, J; Aberant, T; Engemann, AK; Henshall, B; Darby, M; Proch, C; Dellascio, M; Pittman, A; Suminguit, J; Choi, T; Gasparetto, C; Long, GD; Lopez, RD; Sarantopoulos, S; Horwitz, ME; Chao, NJ; Sung, AD
Published Date
- August 2022
Published In
Volume / Issue
- 28 / 8
Start / End Page
- 498.e1 - 498.e9
PubMed ID
- 35595226
Electronic International Standard Serial Number (EISSN)
- 2666-6367
Digital Object Identifier (DOI)
- 10.1016/j.jtct.2022.05.018
Language
- eng
Conference Location
- United States