Burden and impact of multifactorial geriatric syndromes in allogeneic hematopoietic cell transplantation for older adults

Abstract

Multifactorial geriatric syndromes are highly prevalent in older patients with cancer. Because an increasing number of older patients undergo allogeneic hematopoietic stem cell transplantation (allo-HCT), we examined the incidence and impact of transplant-related geriatric syndromes using our institutional database and electronic medical records. We identified 527 patients age 60 years or older who had undergone first allo-HCT from 2001 to 2016 for hematologic malignancies. From the initiation of conditioning to 100 days posttransplant, new geriatric syndromes were predominantly delirium with a cumulative incidence of 21% (95% confidence interval [CI], 18%-25%) at day 100 followed by fall at 7% (95% CI, 5%-9%). In multivariable analyses of available pretransplant variables, fall within the last year, potentially inappropriate use of medication, thrombocytopenia, and reduced creatinine clearance were significantly associated with delirium; age older than 70 years and impaired activities of daily living were significantly associated with fall. In the 100-day landmark analysis, both delirium (hazard ratio [HR], 1.66; 95% CI, 1.09-2.52; P = .023) and fall (HR, 2.14; 95% CI, 1.16-3.95; P = .026) were significantly associated with increased nonrelapse mortality; moreover, fall (HR, 1.93; 95% CI, 1.18-3.14; P = .016), but not delirium, was significantly associated with reduced overall survival. Here, we establish baseline incidences and risk factors of common transplant-related geriatric syndromes. Importantly, we demonstrate significant associations of delirium and fall with inferior transplant outcomes. The burden and impact of transplant-related geriatric syndromes warrant the institution of patient-centered, preemptive, longitudinal, and multidisciplinary interventions to improve outcomes for older allo-HCT patients.

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

“…second, the heterogeneity in diagnosis, donor type especially a small percentage of haploidentical donor, transplant platforms, and post-transplant care may introduce selection biases. Third, in addition to pre-transplant risk factors, allo-HCT itself may introduce additional risk factors for survival such as graftversus-host disease and geriatric syndromes [27].Finally, this is a single institutional study which may not be applicable to other settings. We expect that the upcoming Blood and Marrow Transplant Clinical Trials Network (BMT CTN 1704) CHARM study will help address many of these issues ().…”

Geriatric assessment in older alloHCT recipients: association of functional and cognitive impairment with outcomes

“…32 Furthermore, cognitive impairment is an established risk factor for postoperative delirium 33 and thus may contribute to delirium or falls; these complications have been shown to be associated with inferior NRM and OS after alloHCT. 34 We hypothesized that functional impairment as measured by GA would independently predict worse outcome. Surprisingly, the study did not replicate prior findings of the adverse influence of IADL impairment observed in most prior single-center studies, 12,14,15 although not all.…”

Characterize, Optimize, and Harmonize: Caring for Older Adults With Hematologic Malignancies

“…In addition to higher rates of nonrelapse mortality among older adults, geriatric syndromes such as falls and delirium further complicate alloHCT. 20 Nonolder adult alloHCT engenders loss of function even 3 months after HCT, which may take 1 year to normalize in survivors. 21,22 Restrictive eligibility criteria (e.g., age younger than 70, low comorbidity) are understandable to attenuate rates of complications; yet these restrictions preclude HCT for older…”