Use of allogeneic hematopoietic cell transplantation (alloHCT) is increasing in older patients with hematologic malignancies. Studies suggest that geriatric assessment (GA), incorporating functional measures such as instrumental activities of daily living (IADL), delineates subtle age-related impairments that enhance risk-stratification. The objective of this multiinstitutional retrospective study was to evaluate the prognostic utility of GA metrics collected pre-alloHCT. Eligibility criteria included age ≥50 and pre-alloHCT GA inclusive of at least IADL. Beyond IADL, additional geriatric metrics were collected where available and included Medical Outcomes Study Physical Health score (MOS-PH), Timed Up and Go (TUG), and cognition by Blessed Orientation Memory Concentration (BOMC). Three hundred thirty subjects were included, with a median age of 63 (range 50 to 77). Impairments were frequent: 36% had at least 1 IADL impairment; 14% had TUG ≥13.5 seconds; and 17% had cognitive impairment (BOMC ≥ 7). Median MOS-PH score was 80. IADL and age were not significantly associated with nonrelapse mortality (NRM) or overall survival (OS). In multivariate analysis, only impaired cognition and Hematopoietic Cell Transplant-Comorbidity Index score ≥3 showed an independent association with 1-year NRM (subdistribution hazard ratio [SHR], 2.36; P = .01; and SHR, 2.19; P = .009, respectively). Cognitive impairment independently conferred inferior 1-year OS (hazard ratio, 1.94; P = .01). In a preplanned subgroup analysis in 224 patients aged ≥60 years, cognitive impairment remained the sole GA metric predictive of NRM (2-year NRM: SHR, 2.72; P = .007). These data suggest that cognitive impairment elevates risk of post-alloHCT NRM in older patients.
|Original language||English (US)|
|Number of pages||11|
|State||Published - Jun 23 2020|
Bibliographical noteFunding Information:
Individual investigators were supported as follows: Hellman Fellows award, University of California, San Francisco (R.L.O.); Leukemia and Lymphoma Society grant 6136-14 (M.A.); Marrow on the Move (M.A,); National Institutes of Health (NIH), National Institute of General Medical Sciences (NIGMS) grant 1 U54 GM115458 (V.R.B. and T.K.); NIH, National Cancer Institute (NCI) grants P30 CA036727 (V.R.B.) and 5T32CA009566-32; University of Chicago (B.D.); NIH, National Institute on Aging grant T32AG000212; and the University of California, San Francisco (L.-W.H.). The Center for International Blood and Marrow Transplant Research (CIBMTR) is supported primarily by NIH, NCI Public Health Service grant U24CA076518; NIH, National Heart, Lung, and Blood Institute (NHLBI) grants U24HL138660, OT3HL147741, R21HL140314, and U01HL128568); the NIH, National Institute of Allergy and Infectious Diseases (NIAID); US Health Resources and Services Administration grants HHSH250201700006C, SC1MC31881-01-00, and HHSH250201700007C; and US Office of Naval Research grants N00014-18-1-2850, N00014-18-1-2888, and N00014-20-1-2705. Additional federal support was provided by NHI, NCI grants P01CA111412, R01CA152108, R01CA215134, R01CA218285, R01CA231141; NIH, NHLBI grants R01HL126589, R01HL129472, R01HL130388, R01HL131731; NIH, NIAID grants R01AI128775, U01AI069197, and U01AI126612; and the Biomedical Advanced Research and Development Authority (BARDA). Support was also provided by Be the Match Foundation, Boston Children's Hospital, Dana Farber, Japan Hematopoietic Cell Transplantation Data Center, St Baldrick's Foundation, the National Marrow Donor Program, the Medical College of Wisconsin, and the following commercial entities: AbbVie, Actinium Pharmaceuticals, Inc, Adaptive Biotechnologies, Adienne SA, Allovir, Inc, Amgen, Inc, Anthem, Inc, Astellas Pharma US, AstraZeneca, Atara Biotherapeutics, Inc, bluebird bio, Inc, Bristol Myers Squibb Co, Celgene Corp, Chimerix, Inc, CSL Behring, CytoSen Therapeutics, Inc, Daiichi Sankyo Co, Ltd, Gamida-Cell, Ltd, Genzyme, GlaxoSmithKline, HistoGenetics, Inc, Incyte Corp, Janssen Biotech, Inc, Janssen Pharmaceuticals, Inc, Janssen/Johnson & Johnson, Jazz Pharmaceuticals, Inc, Kiadis Pharma, Kite Pharma, Kyowa Kirin, Legend Biotech, Magenta Therapeutics, Mallinckrodt LLC, Medac GmbH, Merck & Co, Inc, Merck Sharp & Dohme Corp, Mesoblast, Millennium, the Takeda Oncology Co, Miltenyi Biotec, Inc, Novartis Oncology, Novartis Pharmaceuticals Corp, Omeros Corp, Oncoimmune, Inc, Orca Biosystems, Inc, Pfizer, Inc, Phamacyclics, LLC, Regeneron Pharmaceuticals, Inc, REGiMMUNE Corp, Sanofi Genzyme, Seattle Genetics, Sobi, Inc, Takeda Oncology, Takeda Pharma, Terumo BCT, Viracor Eurofins, and Xenikos BV.
© 2020 by The American Society of Hematology.